不同醫療提供型態對監獄收容人醫療服務之影響

The Impact of Different Healthcare Provision on the Prison' Healthcare service

陳秀麗(CHEN.HSIU-LI)

指導教授 ： 龔佩珍 ； 蔡文正

亞洲大學/健康學院/健康管理研究所/碩士(2005年)

摘要

本研究主要目的在於探討：不同規模層級矯正機構，所提供不同醫療型態之醫療服務品質，對收容人就醫滿意度的影響。並分析影響收容人就醫滿意度之因素，進一步以IPA分析法(Importance - Performance Analysis)，了解現今矯正機構醫療工作中最迫切需要改善的服務項目。
本研究以全國各監獄收容人為母群體，根據各監獄所核定之容額大小、醫療提供型態、地域分佈等特性，共畫分為五大層級，以分層隨機抽樣方式，抽取九家監獄進行問卷調查，共計回收有效樣本數1,893份。醫療服務項目主要以「六性」中之「可近性、完整性、適切性、持續性」（簡稱四性）為評量基礎。本研究分別以描述性分析來說明樣本資料分佈特性；雙變項分析探討不同規模層級之監獄收容人對於各項醫療服務滿意程度與重要性認知程度之差異；以線性複廻歸分析來探討影響收容人整體就醫滿意度及「四性」就醫滿意度的顯著因素；最後再採用IPA分析法，來了解現今矯正機構醫療工作中最迫切需要改善的服務項目。
研究結果發現：收容人平均年齡為38.26歲，教育程度以「國中」居多，佔46.12％，已服刑期平均3.5年，男女比例為13：1。不同層級監獄之收容人，其醫療服務滿意度與重要性認知程度均具顯著差異。而廻歸分析結果顯示：收容人基本資料（年齡、教育程度）、健康狀況（是否有重大傷病、是否有慢性病而須固定就醫）、就醫經驗（每月平均購藥費用、每月平均自費看病費用）、不同醫療型態等均為影響收容人整體就醫滿意度之因素。在醫療提供型態部份，除是否有醫院設置外，其中又以自費延醫比例影響程度最高。根據IPA分析結果，滿意度最高的前三項服務項目分別為「醫療環境衛生」、「醫護人員服務態度」、「醫師服務態度」；而重要性方面，收容人最在意的是「醫療藥品治療效果」、「醫師病情解釋」、「監（所）主動安排持續追蹤與治療」等項目。最「迫切需要改善」之項目，對收容人而言，是「出院後，監（所）能協助追蹤複診」以及醫療照護四性中的「持續性」。
針對以上研究結果，本研究提出以下幾點建議，行政方面：一、規劃明確的矯正醫療政策方針，建立完整的醫療服務網絡及權限的劃分，以維護收容人醫療服務品質、發揮實質功能。二、整合現有醫療資源，建立社會與矯正機構醫療服務相互支援的功能。三、推廣培德醫院醫療模式。實務方面：一、參照健保資料庫疾病分類模式，建立收容人完整就醫紀錄。二、針對自費延醫與自費購藥部份，能建立合理收費標準。三、加強改善收容人醫療照護的持續性，建構以符合「病人為中心」的照護參考指標。
關鍵字：矯正機構、收容人、醫療提供型態、醫療服務品質、就醫滿意度、IPA分析法

關鍵字

矯正機構 收容人 醫療提供型態 醫療服務品質 就醫滿意度 IPA分析法

並列摘要

Abstract

The purpose of this study was to investigate (1) prisoners’ satisfaction of health care quality provided by different correctional institutes and (2) the influenced factors associated with their satisfaction. Importance-Performance Analysis (IPA) was employed to investigate the health care services which needed to be improved urgently by correctional institutes.
The study populations were the prisoners in nationwide correctional institutions in Taiwan. Correctional institutions were separated into five levels according to the types of health care services, scopes and regional distributions. Nine correctional institutions were selected using stratified random sampling method. A total of 1893 prisoners were included as the studied samples in this study. Among the six characteristics of health care services, “accessibility,” “comprehensiveness,” “appropriateness,” and “continuity” serviced were treated as the dimensions to evaluate health care quality.
The descriptive statistics showed the prisoners’ characteristics; bivariate analysis explored the differences between prisoners’ satisfaction of different health care services and the percepts of their importance; linear multiple regression analysis was used to investigate the factors associated with the prisoners’ satisfaction of different types of health care services; finally, IPA was employed to find out the health care services which needed to be improved urgently.
The results showed that the prisoners from different scopes of correctional institutions were significantly different in terms of the health care satisfaction and the percepts of their importance. Regression analysis indicated that the following factors had great impacts on prisoners’ satisfaction, such as (1) prisoners’ personal characteristics (age and education level), (2) health status (major/injured illness and chronics disease), (3) experiences of health care services (monthly expenditures of medication and monthly out-of-pocket fees for health care services), and (4) different health care services. In the light of difference types of health care services, the affiliation of hospitals had the greatest impact and followed by the percentage of out-of-pocket fees for health care services. In addition, the results of IPA analysis indicated that the top three health care services that the prisoners most satisfied with were “environmental hygiene,” “attitude/courtesy of hospital staffs,” and “attitude of physician’ consolations.” With respect to the percept of the importance of health care services, “the effect of medication,” “disease explanation,” and “the continuous trace of health care services provided by the correctional institutions” were prisoners’ primary concerns. Subjects also reported that the health care services which needed to be improved urgently were “the subsequent consultation provided by the correctional institutions after hospitalization” and “continuity.”
Based on the result, this study provided the followings suggestions to the administration and fieldwork practice. The suggestions were (1) to establish the specific health care policy and responsibility for the provision of comprehensive health care service network, (2) to integrate health care resources for supporting the health care services between society and correctional institutions, and (3) to promote of the health care services model of Taichung prison Pei-te hospital. For the fieldwork application, the suggestions were (1) to build up prisoners’ medical history referred to the disease categories of Bureau of National Health Insurance (BNHI) dataset, (2) to establish the standard of medical expenditures specifically for out-of-pocket fees for medical services and medication, and (3) to reinforce of the continuity of prisoners’ health care services and to reach the goal of patient-focused health care services.

Keyword : Correctional institution, Prisoner, Types of health care services, Quality of health care services, Satisfaction of health care, Importance - Performance Analysis

並列關鍵字

矯正機構 收容人 醫療提供型態 醫療服務品質 就醫滿意度 IPA分析法

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