探討聯合執業與單獨執業診所之醫療服務品質

To Explore Consumers Perceived Quality of Medical Care Provided by Group Practices and Solo Practices

劉淑銘(Shu-Ming Liu)

指導教授 ： 林恆慶

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(2004年)

摘要

目前對於聯合執業的相關研究著重探討經營模式與調查開業醫對聯合執業的態度，多屬於醫療產業的供給面，較少從民眾之需求來分析，因此本研究的目的是希望從民眾之觀點，比較聯合執業及單獨執業診所之醫療品質差異。 本研究採用Parasurama et al.（1985）所提出的服務品質概念模式為基礎，再參考其建構服務品質量表程序發展出包含有形、可靠、反應、保證、關懷等五構面，與22項服務品質項目，以發展出一個適合測量診所醫療服務品質的問卷，找出於九十二年三月至四月間新成立之四家聯合執業及13家單獨執業診所，每家聯合執業發放150份問卷，單獨執業診所則分別發放50份問卷，共發放出1,250份問卷。 研究結果發現，在控制性別、年齡、教育程度、婚姻狀況、就醫地點後，執業型態與病人感受到診所所提供的有形性、可靠性、反應性、保證性、關懷性五項醫療品質構面有顯著的相關性（R2 =0.19 to 0.30），且聯合診所之醫療服務品質顯著高於單獨執業診所，可能原因為聯合執業診所可 降低個別醫師的成本、可降低臨床及財務上的風險、醫師之間彼此分享臨床經驗，以增加診療正確性、候診時間較短、提昇工作效率並確保服務品質、病歷記錄較完整、提供病人完善的服務、容易推動預防醫學及進行門診品質確保計劃、較能稽核醫療行為的適當性、能提供較佳的醫療照顧、可以提供民眾較高的醫療可近性、可得到各種不同科別的醫療服務、病人有較多選擇、診所隨時都有人值班，因應病人的需求等因素。

關鍵字

聯合執業 ； 單獨執業 ； 服務品質量表

並列摘要

Probe into type of operation and to open for business physician of the investigation to the attitude the group practices emphatically about the relevant research which group practices at present, belong to more supply range of the medical industry, it is less likely to analyse from the people''s demand, so the purpose of this research is to hope from the people''s view, relatively group practices and medical difference of medical care quality of the solo practices. This research adopts Parasurama et al. (1985) Based on the service quality concept way put forward, and then consult it and build and construct and serve the quality form of SERVQUAL the procedure develops out and includes tangibles, reliability, responsiveness, assurance, and empathy etc. on five dimensions, suitable for the questionnaire which measures the medical care quality of the clinic in order to develop one with the quality project of 22 quality attribute items, at all four group practices and 13 solo clinics newly started in the 3-4 months prior to survey, until 150 patients at each group practice, and 50 patients at each solo practice were surveyed, for a total of 1250 patients. The result of study is found, controlling the gender, age , education level, marital status, seek medical advice behind the location, what the clinic offers in operation type attitude and patients’ perceptions, constructing the surface in tangibles, reliability, responsiveness, assurance, and empathy on five dimensions, has significant (R2 =0.19 To 0.30), and the medical care quality of the group practice is higher than the solo practice apparently, perhaps the reason group practice the cost that the operation clinic can reduce the specific doctor, can reduce the risk on clinic and financial affairs, share clinical experience each other among more intact system doctor, in order to increase the exactness of making a diagnosis, the time of waiting to see the doctor is relatively short, promote working efficiency and guarantee to serve quality, write down more intact in case history, offer a perfect service to patients, it is apt to promote preventive medicine and carry on clinic quality to guarantee the plan, the ones that can relatively audit medical behavior are proper, can offer better medical care, can offer people high medical treatment very getting near, can get all kinds of subject other medical care, patient have more choose, clinic someone on duty at any time, because in conformity with the factors, such as the patient''s demand, etc..

並列關鍵字

group practices ； solo practices ； SERVQUAL

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