探討聯合執業與單獨執業診所之醫療服務品質
台灣的剖腹產率平均值維持在 32%-34% 左右，而自民國 76 年 1 月至 94 年 12 月間，移
入臺灣之新移民配偶共計有 364,596 人，即約 36.5 萬人。根據臺灣社會目前剖腹產率居
高不下及新移民婦女遽增之現況，本研究主要是針對居住在臺灣的新移民孕婦，探討新
移民孕婦與本國籍孕婦選擇生產模式之相關因素。
本研究為橫斷性（ cross-sectional design ）研究，採次級資料分析，以「國家衛生研究
院全民健康保險研究資料庫」內 2002 年 01-12 月間，在臺灣地區各級醫療院所分娩之
產婦為研究對象，針對 212,269 名本國籍產婦及 16,858 名新移民產婦進行分析。本研究
使用卡方檢定（ Chi-Square test ）來檢視國籍對孕婦的生產模式是否有差異；另外使用
羅吉斯迴歸分析 (Logistic Regression Analysis) 探討新移民孕婦與本國籍產婦選擇生產模
式之影響因素。研究結果顯示，在使用剖腹生產方面，本國籍產婦有 73,240 人，佔 34.
50% ；新移民產婦有 3,413 人，佔 20.25% （ c2=1426.0985 ， p<0.0001 ），意即孕婦國
籍與生產模式有高度顯著相關。依據羅吉斯迴歸分析結果顯示，新移民孕婦選擇剖腹生
產約為本國籍孕婦的 0.5 倍，（ OR=0.504 ； 95%CI , 0.459-0.553 ； p <0.0001 ）。由此
可見本國籍孕婦較新移民孕婦偏好選擇剖腹生產。
基於本研究的研究發現，建議相關衛生主管機關：（ 1. 透過教育導正民眾的正確生產
觀念， 2. 利用媒體文宣提供孕婦正確的生產資訊， 3. 嚴格規範剖腹生產標準，並加強
剖腹生產案件審查）；建議各級醫療院所與醫院管理階層：（ 1. 需提高醫療照護品質
， 2. 醫療人員生產觀念再教育， 3. 設立新移民孕婦專門門診， 4. 加強新移民家庭之社
區醫療服務）。
To Explore Consumers Perceived Quality of Medic
al Care Provided by Group Practices and Solo Pra
ctices
Probe into type of operation and to open for business physician of the investigation to the attitude the grou p practices emphatically about the relevant research which group practices at present, belong to more suppl y range of the medical industry, it is less likely to analyse from the people''s demand, so the p urpose of this research is to hope from the people''s view, relatively group practices and medi cal difference of medical care quality of the solo practices.
This research adopts Parasurama et al. (1985) Based on the service quality concept way put forward, and th en consult it and build and construct and serve the quality form of SERVQUAL the procedure develops out and includes tangibles, reliability, responsiveness, assurance, and empathy etc. on five dimensions, suitable for the questionnaire which measures the medical care quality of the clinic in order to develop one with the quality project of 22 quality attribute items, at all four group practices and 13 solo clinics newly started in t he 3-4 months prior to survey, until 150 patients at each group practice, and 50 patients at each solo practic e were surveyed, for a total of 1250 patients.
The result of study is found, controlling the gender, age , education level, marital status, seek medical advi
ce behind the location, what the clinic offers in operation type attitude and patients’ perceptions, constructi
ng the surface in tangibles, reliability, responsiveness, assurance, and empathy on five dimensions, has sig
nificant (R2 =0.19 To 0.30), and the medical care quality of the group practice is higher than the solo practi
ce apparently, perhaps the reason group practice the cost that the operation clinic can reduce the specific do
ctor, can reduce the risk on clinic and financial affairs, share clinical experience each other among more int
act system doctor, in order to increase the exactness of making a diagnosis, the time of waiting to see the d
octor is relatively short, promote working efficiency and guarantee to serve quality, write down more intact
in case history, offer a perfect service to patients, it is apt to promote preventive medicine and carry on clin
ic quality to guarantee the plan, the ones that can relatively audit medical behavior are proper, can offer bet
ter medical care, can offer people high medical treatment very getting near, can get all kinds of subject othe
r medical care, patient have more choose, clinic someone on duty at any time, because in conformity with t
he factors, such as the patient''s demand, etc..
