金門縣民眾縣外就醫影響因素之探討

An Investigation of Determinants for Kinmen Residents to Seek Medical Care Out of County

陳天順(Tien-Shun Chen)

指導教授 ： 楊哲銘

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

本研究旨在分析金門縣民眾縣外就醫情形與民眾特質及醫療服務滿意度之關係。針對金門縣五鄉鎮之20-69歲民眾，以電話訪問的方式進行問卷調查，共完成訪查823人，回收的有效問卷在各鄉鎮及年齡、性別分佈上經檢定結果具有樣本代表性。 問卷調查縣外就醫的比率、醫院別及科別，探討民眾對金門縣醫療服務的滿意度，同時調查民眾對政府醫療施政的看法。 研究結果發現，民眾縣外就醫的比率為34.1％，赴台灣就醫的醫院以醫學中心為主，其中榮民總醫院佔22.5％，三軍總醫院佔20.4％，長庚紀念醫院佔15.4％；民眾自己決定專程前往台灣就醫佔50.3％，醫師建議轉診佔35％，有事到台灣順便看病佔14.7％。本研究同時調查民眾對金門縣整體醫療服務的滿意度，表示滿意及非常滿意佔15.5％，表示不滿意及非常不滿意佔41.1％；不滿意的原因是缺乏醫療設備、醫師經驗或能力不好、醫護人員不足、醫療服務科別不足。 研究結果發現縣外就醫行為的影響因素為民眾個人特質中之傾向因素的變項為年齡60-69歲者；能用因素的變項為知道利用交通費補助者；需要因素的變項為最近一年有看過病者及患有慢性病者比較多縣外就醫行為，對醫療服務表示滿意者，則較少縣外就醫行為。 對於政府醫療施政方案，受訪者認為最重要的三項為：一、增加醫療設備（95.7％）二、加強現有醫師素質（94.3％）三、接洽大型醫院支援更多的專科醫師（94％）；其次重要的為：一、改善醫護人員的服務態度（79.4％）二、籌建一棟具有300床以上具有區域醫院功能的大型醫院（71.2％）最後一項是將金門縣立醫院提昇為署立醫院並由中央負責經營管理（63.6％）。本研究建議主管機關先加強金門縣醫療機構的醫療設備，同時提昇專業人員的質與量，並積極籌建具有區域醫院功能的醫療大樓，以提供民眾更高品質的醫療服務，預期可減少縣外就醫的人次。

關鍵字

金門縣 ； 縣外就醫 ； 醫療服務 ； 滿意度

並列摘要

The purpose of this research is to study the relationship among the Kinmen residents’ characteristics, in county care patient satisfaction, and the out of county medical care seeking behavior. The study population is the 20-69 years old residents of five villages and towns in Kinmen county, an offshore island of Taiwan. We conducted telephone interviews based on a structured questionnaire and had been able to conduct 823 valid interviews. The respondents are statistically representative of the target population in age, sex and geographic distribution. The questionnaire inquired about the percentage of out of county care seeking, the preferred inland hospitals and specialties, the degree of satisfaction with the medical services rendered in Kinmen, and at the same time people’s view of the healthcare policy of Kinmen County government. The results of this research indicate that the proportion of seeking outside-county medical care is 34.1％. People primarily go to Taiwan for the medical services in medical centers. Among them, the Veteran General Hospital accounts for 22.5％, the Tri-Service General Hospital 20.4％, Chang-Gung Memorial Hospital 15.4％. The respondents who decide on their own to go to Taiwan to seek medical care account for 50.3％ of the total respondents; whereas, those who go via referral by their doctors account for 35％. 14.7％ of the respondents go to Taiwan for medical care by coincidence. This research also investigated the degree of patient satisfaction for medical services rendered in Kinmen’s medical facilities. 15.5％ of the respondents expressed being very satisfied or at least satisfied. 41.1％ of the respondents are very unsatisfied or unsatisfied. The reasons for dissatisfaction are lack of medical equipments, physicians’ incompetence and inexperience, shortage of medical personnel and medical specialists. The significant determinants for out of county medical care seeking behavior are age between 60-69 years old (predisposition factor), knowledge of the transportation subsidy for going to Taiwan (enabling factors), frequency of falling sick, the existence of chronic diseases (need factors), and satisfaction with the medical services. In order to increase the satisfaction of Kinmen’s local medical services and reduce the percentage of people who go out of county to seek medical care, the three most important policy suggestions to the local government based on the responses of this research are as follows: (1) Must increase medical equipments (95.7％). (2) Strengthen the ability of local doctors (94.3％). (3) Line up major hospitals to provide specialized care in Kinmen (94％). There are also another three policy recommendations of lesser importance as viewed by the respondents: (1) The service attitude of medical personnel must improve (79.4％). (2) Build a regional hospital which has the capacity of over 300 beds (71.2%). (3) Kinmen County hospital should be elevated to be a national hospital which is put under the direct supervision of the Department of Health (63.6％).

並列關鍵字

Kinmen county ； out of county medical care seeking ； medical services ； patient satisfaction

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