目標:為提昇醫療服務品質、合理控制醫療費用,提高專業自主性,全民健保中醫門診總額支付制度於八十九年七月正式實施。為避免總額支付制度實施後,醫療服務品質降低,本研究在該制度實施前以病人滿意度的觀點建立一套評估的工具,以了解病患對中醫門診醫療服務品質及收費合理性滿意度現況及其影響因素。方法:以89年6月中醫門診總額實施前之門診就醫病患為研究對象,先依縣市及院所分層抽取中醫院所(醫院抽50%,診所抽40%),復就抽中院所提供之八十九年六月十六日之所有病人名單以系統抽樣,電訪成功之有效樣本1837人(完訪率77%)。資料鍵入電腦後,藉由事後分層加權法以使樣本分布與母群體一致,資料以SPSS for windows9.0版進行描述性及T檢定、ANOVA、相關分析、卡方檢定與複迴歸分析等推論性統計。結果:中醫門診病人整體醫療服務品質滿意度平均達78.5分,醫療品質各構面滿意度得分差異不大,以照護可近性最高(平均值80.5%),醫療設備及環境最低(平均76.1分);收費合理性滿意度(平均值71.09分)又較醫療品質滿意度低。就診台北分局之病人滿意度較其他分局低。經控制病人及院所特性後,針灸治療有採拋棄式用針者、給藥天數較長者、由中醫師親自執行傷科處置或針灸治療者、醫師主動提供保健說明及醫師看診時間較長者滿意度較高;反之,交通及候診時間較長及被差額收費者滿意度較低。結論:(1)中醫醫療品質大致可為病人接受,惟仍應落實由醫師親自執行針灸及傷科醫療,避免不當之差額收費。(2)本研究發展之問卷可作為健保局定期監控民眾對中醫門診就醫可近性、醫療服務品質滿意度及差額負擔之工具。
Objectives: To evaluate the quality of care (QOC), the extent of balance billing and the associated factors before the implementation of the Global Budget Payment System of Ambulatory Chinese were conducted on samples based on stratified random sampling of the providers, and their lists of patients on June 16, 2000. A total of 1837 interviewed were completed (response rate 77%)during June 20 to 30, 2000. Post-stratification was conducted to adjust the age-county distribution of the samples: Multiple linear regressions were conducted. Results: (1)The average overall patients' satisfaction on QOC was 78.6 out of 100; among the different dimensions of QOC, ”accessibility” ranked the highest (80.5) whereas the” medical equipment” ranked the lowest (76.1). The satisfaction on “ reasonableness of the charge” was lower than QOC(7l.1). In general hospital patients were less satisfied than that of clinics. Patients in the Taipei Branch Bureau of NHI were less satisfied than others. (2)After contro1linl! for the patients' and providers' characteristics, the following factors were related to higher satisfaction of QOC: use disposable needles in acupuncture; more days on prescription; Physicians conduct traditional traumatic procedures, acupuncture or moxibustion by themselves; or provided more preventive or self care information; longer visiting time; shorter traffic time / waiting time; no extra-charge. Conclusions: (l)The overall .patients' satisfaction of quality of care and balance-billing were acceptable. However, to improve satisfaction, physicians should conduct traditional traumatic; acupuncture/moxibustion therapies by themselves, to avoid the extra-charge to patients if possible.(2)The instrument developed by this study could be used to monitor the accessibility ,quality and balance-billing of the providers after the implementation of the GB-CM.
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