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  • 學位論文

門診感受的等候時間分析與管制

Analysis and control of Perceived Waiting time in the clinics

指導教授 : 陳正剛

摘要


全民健康保險法自民國83 年公佈實施以來,台灣的醫療照護服務儼然成為世界上很多國家的楷模。但是全民健保制度也一直面臨財務無法平衡的問題,導致很多的討論反而是在成本的控制而並非照護品質的提升。醫療機構在全民健保制度的財務壓力與成本控制下,對於照護的提供皆是被動的提供。主動去了解病患的需求所在並配置資源去滿足,被認為是高負擔高成本的做法,因此大多醫療機構誤以為主動式的服務只會增加資源負擔與成本。事實上,主動式的服務不但可以大幅提升照護品質,甚至可以有效得降低資源成本。醫院的檢查結果是重要的診斷根據,很多門診時間必須依檢查排程時間來做後續安排,也因此檢查的排程成為整個醫療機構作業流程的關鍵,過長的等候時間更是病患與醫療人員抱怨的主要來源,故有許多既有的文獻研究如何最佳化檢查排程來縮減等候時間。然而病患衡量自己等候了多久完全是一種主觀意識,可能會因為外在因素的影響而與實際等候長度有所落差,因此針對實際等候時間的服務品質改善效果也相對降低。故本研究主要探討病患的感受等候時間,並根據文獻考慮外在因素對感受等候時間的影響,我們定義了等候感受過程與等候感受狀態來描述感受等候時間的變化型態,並利用效用模型分析建構等候感受型態模型。利用觀察到的感受等候時間與實際等候時間資料,我們不但建構等後感受型態模型,更進一步建構感受等候時間的統計管制圖,以維持病患等候的服務品質。

並列摘要


Since its implementation of the National Health Insurance policy in 1994, the service of health-care in Taiwan has been said to be a good role model to many other countries around the world. However, most people think that controlling cost is more important than improving the quality of services of health-care because of the financial imbalance of the National Health Insurance System. Based on both financial pressure and controlling cost of the system, medical institutions in Taiwan provide relatively passive service in contrast to the proactive service that takes the initiative to understand patients’ demand and to meet patients’ satisfaction, and the active service is believed to only increase the financial burden. In fact, the proactive service can not only improve the quality of services of health-care, but also reduce the resource cost significantly. The waiting time in queue for outpatient visit in medical facility is one of the most critical service quality characteristics. The main source of complaint from patients is their long waiting time. Thus, many researches have focused on how to optimize the outpatient schedule in a clinic to reduce patients’ actual waiting time. However, it is entirely a subjective matter for patients to feel their waiting time which might be different from the actual waiting time as a result of many external/environmental factors. Therefore, reducing the actual waiting time might not get the best benefits for improving the quality of services. This research will discuss about patients’ perceived waiting time. Based on the proposition of previous Psychology literature about how the external factors have impact on the feelings of waiting time, we propose methods to describe patient’s process of perceived waiting time. It is proposed that the waiting is comprised of the waiting process and the waiting state. We use utility models to model the relationship between the perceived waiting time and the actual waiting time. We also propose methods to establish the control chart of perceived waiting time by using perceived waiting time statistical distribution and the utility model. With the control chart, we can maintain patient’s satisfaction by controlling the perceived waiting time, instead of the actual waiting time, in an acceptable range.

參考文獻


1. Holt, C.A. and S.K. Laury, Risk aversion and incentive effects. American economic review, 2002. 92(5): p. 1644-1655.
2. Maister, D.H., The psychology of waiting lines. 1984: Harvard Business School.
3. Thompson, D.A., et al., How accurate are waiting time perceptions of patients in the emergency department? Annals of emergency medicine, 1996. 28(6): p. 652-656.
4. Chateauneuf, A. and M. Cohen, Risk seeking with diminishing marginal utility in a non-expected utility model. Journal of Risk and Uncertainty, 1994. 9(1): p. 77-91.
5. Pruyn, A. and A. Smidts, Effects of waiting on the satisfaction with the service: Beyond objective time measures. International Journal of Research in Marketing, 1998. 15(4): p. 321-334.

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