新醫院的成立對當地民眾就醫行為之影響─以北區 某區域教學醫院為例
論文名稱 : 新醫院的成立對當地民眾就醫行為之影響─以北區某區域教學醫院為例
研究所名稱 : 臺北醫學大學醫務管理學研究所 研究生姓名 : 林汝勳
畢業時間 : 97 學年度第 2 學期
指導教授 : 郭乃文 臺北醫學大學醫務管理研究所教授
全民健康保險自民國 84 年 3 月實施以來，對醫療產業造成巨大的影響，然而，雖然受到健保支付制度的限制，近幾年大型醫院仍陸續的成 立。研究指出，新醫院的設立，尤其是大型醫院的設立，對於當地的醫療照護水準，必然能有所提升，而近年來針對民眾的就醫行為之研 究也愈來愈受到重視。個案醫院於民國 94 年 12 月設立，為當地唯一的大型醫院，對於當地民眾的就醫行為勢必會受到影響。
本研究主要為探討汐止當地民眾的就醫選擇因素，及個案醫院成立後當對地民眾就醫行為之影響。研究目的包括 : (1) 探討新醫院的成立是 否會影響當地居民的就醫行為變化； (2) 瞭解民眾不同就醫選擇因素對於就醫行為之影響。本研究採用橫斷式研究，針對汐止地區 20 歲以 上之成年人進行問卷調查，轄區內共 46 個里採「戶內任意成人法」依每一里之戶數比例分配樣本數，共訪查 2,105 位民眾，回收有效樣本 總計 1,477 份，問卷回收率為 70.17% 。利用 SPSS 統計套裝軟體進行分析，包含描述性統計、卡方檢定、單因子變異數分析及羅吉斯迴歸 分析等，以探討當地居民就醫行為之變化，以及就醫選擇因素對醫療行為之影響。
研究發現：
一、 民眾就醫選擇因素中，醫療服務品質因素最受到民眾的重視。尤其是對醫師的醫德與醫術重視程度最高，但對時間性因素與方便性因 素的重視程度則相對較低。
二、 新醫院的設立確實會對當地民眾的就醫行為造成影響。研究發現個案醫院設立前後樣本就醫行為變化中，當地居民到醫院就醫的意願 增加者佔 52.3 ％、每年就醫次數增加者佔 28.4 ％及整體就醫之方便性增加者佔 63.8 ％；跨區就醫的次數減少者佔 58.1 ％，而就醫的交通 時間及所花費的時間減少者分別佔 62.5 ％及 60.0 ％。另對於影響就醫行為的因素中，包含經濟因素、社會心理因素、年齡、婚姻、有無慢 性病及自覺健康狀態等皆會對就醫行為造成影響。
三、 當地民眾對個案醫院的認知程度高（ 89.4% ）。有 91.9% 的民眾表示會至個案醫院就醫，而曾至個案醫院就醫的民眾也有 60.6% 的感 到滿意，但其中感到非常滿意的僅占 9.8% ，顯示個案醫院在醫療服務提供仍有努力改進的空間。
四、 人口特質會對就醫行為造成影響。個案醫院設立後，確實增加了當地居民就醫的可近性及醫療使用的頻率，自認患有慢性病的民眾在 個案醫院成立後，至醫院就醫的意願增加，但每年就醫次數則呈現減少或沒有影響。
根據研究結果本研究提出建議如下： (1) 個案醫院可針對民眾不滿意的部分進行改善，及加強當地常見的慢性疾病之醫療服務內容，並可增 加社區活動以增進當地民眾對個案醫院的認知； (2) 主管機關可針對尚無醫院設立之地區評估醫院設立之可能性，以增進民眾之就醫可近性
； (3) 後續研究者可利用健保資料庫對醫療利用進行進一步的分析，並比較其他有新設醫院地區的醫療行為變化。
關鍵詞：就醫選擇因素、就醫行為、新設醫院
Impact of a Newly-opened Hospital on Residents’
Behavior in Seeking Healthcare － An Example of a Regional Teaching Hospital in Northern Taiwan
Title of Thesis: Impact of a Newly-opened Hospital on Residents’ Behavior in Seeking Healthcare － An Example of a Regional Teaching Hospital in Northern Taiwan
Author: Ju-Hsun Lin
Thesis advised by: Nai-Wen Kuo, Ph.D., M.P.H.
Since Taiwan’s National Health Insurance (NHI) came into practice in March 1995, it has left quite an impact on the healthcare industry. Although a majority of the hospital’s income comes from the restricted Payment Schedule of NHI, still, many large-scale hospitals are being set up in recent years.
Studies have shown that new hospitals, especially large-scale ones, will improve the quality of healthcare for the locals. Consequently, studies on the p ublic’s behavior in seeking healthcare are gaining tremendous focus. The hospital in this study was established in December 2005, and is the only regi onal teaching hospital in Sijhih. Its establishment would surely have an effect on local residents’ behavior in seeking healthcare.
This study has two aims: 1) to explore the differences of behavior in seeking healthcare after the hospital is established, 2) to understand how the decid ing factors can affect local residents’ behavior in seeking healthcare. This study is a cross study of adults over 20 years of age from 46 neighborhoods i n Sijhih. Total of 2,105 adults were surveyed and 1,477 questionnaires were collected; the recall rate was 70.17%. This study uses the SPSS statistical software package and conducts descriptive statistics, chi-square test, one-way ANOVA and Logistic regression.
Results from the study are as follows:
1. Quality of healthcare, especially in medical ethics and medical skills is the most valued factor in choosing a hospital. On the contrary, time and conv enience factors are less valued.
2. A newly-opened hospital does indeed affect local residents’ behavior in seeking healthcare. The results show an increase in hospital use and accessi bility, and a decrease in frequenting hospitals in other regions. Factors such as economic, socio-psychological , age, marriage, self-perceived health, ch ronic disease also have an effect on healthcare seeking behavior.
3. The participants highly identify with the hospital (89.4% ） . 91.9% of residents indicate they are willing to seek medical care at the hospital. 60.6%
who has been to the hospital feel satisfied with the facility, but only 9.8% feel very satisfied. This means the hospital has room for improvement.
4. The demography of the region affects residents’ behavior in seeking healthcare. After the hospital was open, people who suffer from chronic disease are more likely to seek medical care there, however, frequency of visit declined or shows no changes.
Based on the result of this study, we suggest the following: 1) the hospital in this study can improve on what local residents are not satisfied with and e nhance the services for common chronic diseases. It can also increase on medical activities within the community to help local residents identify with t he hospital. (2) The government can evaluate the possibility of setting up hospitals in areas that have no hospitals to increase medical care accessibility . (3) Future research may use NHI Research Database to analyze the changes in hospital use, and compare with other areas new hospitals are set up.
Keywords ： Factors of selecting healthcare providers, Behavior of seeking healthcare, Newly-opened hospitals
