影響澎湖地區民眾醫療轉診行為之探討

The Studies of the Determined Factors Influencing the Medical Referral Behaviors for the People in Penghu County

呂宏志(Hung-Chih Lu)

指導教授 ： 張肇松

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2011年)

摘要

研究目的
為了瞭解目前澎湖地區居民其轉診行為、影響轉診相關因素，本研究擬在目前離島醫療資源欠缺之醫療環境下，探討探討民眾特性、社會資源、醫療機構特性及政府政策對於民眾轉診行為的影響，並透過醫療轉診行為來探討澎湖地區在地醫療需求，提高醫療品質，並降低轉診醫療成本。
研究方法
本研究採橫斷式研究，結構式問卷之方式收集資料，使用SPSS14.0中文版統計軟體進行建立相關資料檔。從技術品質、醫病關係、醫療可近性、社會信任、社會網絡、轉診認知六個面向來探討影響轉診行為的因子；調查區域範圍為澎湖縣五鄉一市；調查對象為在澎湖地區設有戶籍之12歲以上常住人口，中選樣本（人）即為受訪對象。調查母群體與抽樣底冊以民國99 年12 月31 日「澎湖地區戶籍資料檔」之戶籍人口為抽樣母體。樣本的選取採取分層抽樣設計，對各鄉市依據人口比例，選定抽樣比例，算出各鄉鎮市的分層抽樣人數，然後以抽取率千分之五進行簡單隨機抽樣。
研究結果
研究結果發現，研究變項方面，醫療技術品質及社會信任會影響其轉診行為；在個人屬性方面，年齡、職業、婚姻與轉診行為均有顯著差異。另ㄧ方面，在健康狀況方面，自覺健康狀況等與有無轉診經驗有顯著差異，有常見慢性身體疾病者與有無轉診經驗有顯著差異，但在心理疾病方面則無顯著差異；民眾對於轉診政策方面，對轉診制度認同者與轉診行為有顯著相關，門診次數與住院次數與轉診經驗呈現正相關。

關鍵字

醫療轉診 ； 轉診意願 ； 轉診行為

並列摘要

The main purpose of this study is to realize the influences of the characteristics such as social resources, medical institution of the community characteristics and effects of government policies on the public referral behaviors of Penghu population. Meanwhile, the object to cut medical referral expenses down for improving the quality medicare of Penghu residents is also well discussed in this article.
We adopt mining cross-study and use structured questionnaires to collect data and establish the relevant data by applying the Chinese version of SPSS14.0 software. There are six factors including technical quality, doctor-patient relationship, medical trust accessibility, social cognition, social networking and referral stance chosen to study the influencing of referral behavior-oriented investigation throughout the Penghu county. We choose the household registration of the resident population aged 12 or above in Penghu county as the survey objects. Survey population and sample a bound copy of a document is based on the file to December 31, 99 ”Penghu area census data” of the registered population as sample matrix. Sample selection taking is based on stratified sampling design. The rural municipality varies because of their populations. The principle of select extract ratio is due to the calculated numbers of stratified sampling in every town, then extract simple random sampling rate of 5 per thousand.
The results indicate that both medical quality and cognition of variable factors mediate the referral behaviors of the samples. The variation in age, occupations and martial status of personal factors also makes the significant differences in referral behaviors. It also makes dramatically differences in terms of consciousness health situation, life stress and with or without chronic diseases and experiences of previous referral. However, having mental diseases or not doesn’t make any difference in this study. As for policy, agreement for referral system is meaningfully related with referral behaviors. The times of outpatient and inpatient is positively related with referral experiences.

並列關鍵字

Medical referral ； Referral intentions ； Referral behaviors

參考文獻

中文部份

王香蘋 （2002）。影響我國分級轉診制度發展因素的探討，弘光學報，40 期，45-51頁。

台灣醫療保險體系部份負擔與轉診方案的政策轉析（2001）；台大社會學刊；29；111-84。

行政院衛生署（1986）；『醫療保健計畫─籌建醫療網計畫』。

行政院衛生署（2000）；醫療網第四期計畫(核定本)─新世紀健康照護計畫。