台灣外籍新娘對婦產科診所就醫評價之研究

Assessment of OB/GYN Clinic Services：A Study of Women in Transnational Marriages in Taiwan

周天給(Tian-Jii Jou)

指導教授 ： 許怡欣

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2005年)

摘要

2004年東森新聞S台報導台灣跨國婚姻的外籍新娘(包括大陸港澳)已達35萬人，成為台灣五大族群之一。由於她們面臨有語言上的溝通障礙，及全民健康保險申請資格的限制問題，造成許多就醫上的困難。這些跨國婚姻出生的下一代是我們國家的一份子，其醫療人權的被重視，及公共衛生的共同防疫與醫療照護措施都是應關注的地方。因此外籍新娘選擇婦產科診所就醫的主要考量因素，對婦產科診所就醫的滿意度，以及影響她們對診所評價的因素，都是其基本醫療權益應關注的議題。惟此一議題卻一直無人重視及研究，故本研究旨在探討台灣外籍新娘對婦產科診所之就醫評價情形。本研究為橫斷性研究，以全台灣基層婦產科診所之就醫婦女為研究對象。研究內容包含量性研究與焦點團體討論兩部分。在量性研究方面，本研究採用自填式結構問卷，印製併有中文與外籍新娘國籍語言之問卷，針對在台灣婦產科診所就醫的本籍、東南亞外籍及大陸新娘進行問卷調查。藉此瞭解外籍新娘對台灣在醫療服務上的期待，亦藉由對醫療服務的滿意度來瞭解其在醫療人權上得到的重視與關懷。本研究共發出1645份問卷，回收之有效問卷為916份，有效問卷回收率為55.7%。在焦點團體討論方面，針對一位台灣婦女、六位外籍新娘(包括大陸)及其家屬，總共十位受訪者進行深入的焦點團體討論，以瞭解她們在台就醫過程中所遭遇的困難，及其對台灣醫療環境與政策之建議。本研究之主要結果如下： 一、 東南亞之外籍新娘選擇診所就醫的考量因素，其優先順序為離家近，其次為親戚朋友或醫師推薦和醫術高明、好口碑。其選擇之考量因素與中國大陸新娘或台灣婦女相似。 二、 東南亞之外籍新娘或中國大陸新娘對診所人員沒有給予歧視之滿意度顯著比台灣婦女的滿意度差。而台灣婦女對診所具有新穎的現代化醫療設備、附近停車方便、及對時間面向的滿意度顯著比東南亞籍或中國大陸籍新娘的滿意度差。 三、 不論是東南亞籍、中國大陸籍或台灣籍之婦女在對整體診所之評價，包括整體服務滿意度、再診意願與推薦親朋好友至就醫診所看診之意願，在不同城鄉別的診所，或不同醫師性別看診，皆無統計上顯著差異。但對就醫診所的某些面向滿意度，東南亞籍、中國大陸籍或台灣婦女卻各有顯著差異。 四、 由焦點團體訪談發現，東南亞籍或中國大陸籍新娘缺乏關於全民健保及社會福利的資訊，以致於失去獲得某些機構提供如產前檢查或醫療服務的權利。且東南亞籍新娘的語言溝通問題是她們就醫上最大的障礙，因此加強中文教育也是迫不及待的事情。 本研究之結果除可做為衛生主管機關對不同族群提供醫療的參考外，亦建議成立全國性專責外籍新娘健康照護諮詢與危難處理中心，以提升照顧此一族群婦女的照護品質，並確保其得到與本籍婦女在醫療人權上相等的權利。

關鍵字

跨國婚姻 ； 外籍新娘 ； 婦產科診所 ； 就醫評價 ； 就醫滿意度 ； 就醫選擇

並列摘要

It was reported by EETV station that the transnational marriage exceeded 350,000 cases in 2004, becoming one of the top five sub populations in Taiwan. Due to the barrier of communication by language as well as the application regulation for the National Health Insurance, the difficulty in utilizing health care service will occur. As the parity of the utilization of medical resources, the advocating of quarantine and the promotion of health education, we should well take care of the candidate of citizen. Unfortunately, there is hardly any research focusing on this area. Therefore, the purposes of this study were to understand the major factors in foreign brides’ selection of OB/GYN clinics, their satisfaction with OB/GYN clinical services of women in transnational marriages in Taiwan, the influence factors of assessing services provided by OB/GYN clinic. This study was employed by retrospective approach, divided by quantitative and focus grouping discussion two sections, the studied population based on those women serviced by all OB/GYN clinics in Taiwan. In quantitative approach, the questionnaire was designed by self-filled-in, printed by Chinese and mother-tongue of foreign brides, and divided by native, Southeastern Asian and Mainland-China brides. We tried to understand foreign brides’ expectation in health care service and satisfaction toward the focus and care of the human right. The questionnaire by 1,645 copies were sent, totally 916 returned, the correspondent rate by 55.7%. Focus grouping discussion was held by ten participatants, one native married woman, 6 foreign brides and their families, to describe their difficulty in utilizing health care services and as their suggestions as the reference of future health polices. The main findings are as follows: 1. From the Southeast Asian foreign brides’ point of view, the three most important factors determining the choice of clinics were distance, recommended by friends and /or relatives and the words of mouth for the clinic. The finding is similar to Mainland-China brides and native married women. 2. Compared with native married women, either Southeast Asian or Mainland-China brides has significant difference in their relatively low satisfaction in medical staff’s non-distortion service. However, in the utilization of advanced medical equipments, the convenience of parking, and total utilization time of health care service, the native married women has significantly less satisfaction compared with the other two groups. 3. In the matrix of county/ gender over total service satisfaction, willing of re-visit and referral to family and friends, no matter in native, Southeastern and Main-China brides, there is no significant difference shown in the results. However, items within the clinics, it does vary. 4. Via focus group forum, Southeastern Asian and Mainland-China brides relatively lack of sources of information for National Health Insurance and social welfare might lead to the loss of entitlements like prenatal examination and obstetric services provided by the system. Also, verbal communication difficulty is one of biggest problems for Southeastern Asian brides. To provide the Chinese courses for them will be one of the major issues in the near future. In conclusion, the findings in the study can be the reference of future health policy implementation for the government. Also, it is suggested that the government should set up a national-wide healthcare counseling and emergency center dedicated for foreign brides in order to provide better service quality and ensure the equality of right in health care service compared with the native married women.

並列關鍵字

transnational marriages ； foreign brides ； OB/GYN clinic services ； assessment of services ； patient satisfaction ； choice of clinics

參考文獻

參考文獻 中文部分 王乃弘(1999)。民眾就醫選擇之研究-分析層級程序法之應用。中華衛誌，18 (2)，138-151。

夏曉鵑(2000)。資本國際化的國際婚姻-以台灣的「外籍新娘」現象為例。台灣社會研究季刊，(38)，11-58。

鄧小雅(1999)。地區教學以上醫院推行品管圈活動之主觀成效及其影響因素之探討。國立台灣大學公共衛生學院醫療機構管理研究所碩士論文。 劉又榕(2004)。美國保障外籍新娘家暴受害可透過社福機構取得綠卡。東新新聞電子報洛杉磯報導，網址:http://www.ettoday.com/2004/07/14/11183-1657725.htm。 蔡文正 & 龔佩珍(2003)。民眾對基層診所評價與就醫選擇影響因素。臺灣公共衛生雜誌，22(3)，181-193。

薛承泰(2003)。台灣地區婚姻的變遷與社會衝擊。國家政策論壇季刊秋季號。台北:國家政策研究基金會。 韓揆(1994)。醫療品質管理及門診服務品質定性指標。中華衛誌，13(1)，35-52。

林雅齡(2004)。影響醫院面臨危機時所採取形象修復策略的相關因素探討。國立台北醫學大學醫務管理研究所碩士論文。