病患忠誠影響來源與醫院、醫師中介關係之研究-以台中地區醫院為例

顧客忠誠的對象可分為員工層次及企業層次，二者之間會相互影響。關係行銷的目的是希望與顧客之間建立牢固的關係，以達到組織績效。因此，企業需要透過長期與顧客互動和相關利益來維護和建立顧客關係。在台灣絕大多數醫師是由醫院所雇用與醫院彼此都有約僱關係。而門診病患就醫選擇的考量因素包括醫師(員工層次)與醫院(企業層次)。本文從病患忠誠關係之觀點，檢視病患對醫師忠誠與醫院忠誠的因果關係是否不同，並探討兩種忠誠的相互移轉作用及其影響強度。本研究以分層抽樣方法針對台灣中部濱海地區三家連鎖醫院門診病患進行問卷調查，根據280份回收的病患樣本，並以結構方程模型(structural equation modeling; SEM-PLS )進行結構模型(structure model)驗證。研究結果發現:病患對醫師忠誠和醫院忠誠的來源是不同的，而且病患對醫師忠誠並不一定會直接產生醫院忠誠。無論病患忠誠對象是醫師或醫院，病患在知覺利益(醫院與醫師)與忠誠其中介變數(醫師額外關懷行為、醫院聲望及醫院轉換成本)之間皆有中介效果，且不同的中介變數對醫師忠誠和醫院忠誠的影響效果也是不同的。

關鍵字

病患忠誠；知覺利益；醫師額外關懷行為；醫院聲望；醫院轉換成本

並列摘要

The object of loyalty between physician-patient relations revolves around employees(physicians) and enterprises(hospitals). This paper aims to compare the various physician-patient relationship modes of these entities with the same patient and two distinguished loyalties (patient loyalty towards physician and hospital, respectively) at the same time. Relationship marketing aims to build a strong relationship with customers, to obtain organizational performance. Therefore, the enterprises must to maintain and build customer relationships through long-term engagement with customer interactions and related interests. Taiwan's physicians are employed by hospitals and have an employment relationship with each other. Therefore, the considerations for the selection of outpatients for medical treatment include physicians (employee level) and hospitals (enterprise level). From the patient's dual loyalty relationship, this paper examines whether the patient's causal relationship between different loyalty objects (physicians and hospitals) is different and discusses the mutual transfer of loyalty and its impact strength. In this study, a convenience sampling method was used to conduct surveys on outpatients at three chain hospitals in the coastal area of Taichung (i.e. central Taiwan), and based on 280 useful samples of patients is applied with a structural model modeling (SEM-PLS) model verification. The results show that patients have different sources of patient loyalty towards physicians and hospitals, and patient loyalty towards physicians does not necessarily lead directly to patient loyalty towards the hospital. Regardless of whether the patient's loyalty target is a physician or a hospital, the various mediators (i.e. physician extra caring behavior, hospital reputation, and hospital switching costs) will have the effect of patient’s perceived benefits (hospitals and physicians) on loyalty. The findings provide several implications for researchers and managers regarding how perceived benefits form hospital and physician and mediators can enrich healthcare service encounters and how to manage patient-physician-hospital relationships properly.