The Impact of Medical Service Quality on Perceived Value in Rural Area－Perceived Behavioral Control as a Moderator.

[[abstract]]民國八十四年健保開辦以來，醫療費用降低，造成民眾朝向大醫院集中，加速淘汰小型醫院使其面臨經營困境。而地區醫院的價值與目的，在於增進醫療公平性與可近性，保障民眾就醫權利。尤其醫療資源不足的偏鄉地區，更有其存在的必要。政府推行許多補助政策與醫療政策希望能更公平的分配醫療資源，地區醫院本身的經營策略也是左右成敗的一大關鍵。 許多研究利用醫療服務品質與知覺價值及滿意度探討民眾就醫的意願。本研究則利用醫療服務品質、知覺價值、計畫行為理論(Theory of Planned Behavior, TPB)的構面，以及利用重要性－績效分析法((Importance-Performance Analysis, IPA)，試圖了解病患知覺到的地理可近性與醫院熟悉度在這其中扮演的角色，讓政府機關及偏鄉醫療院所了解在醫療資源匱乏地區中醫療院所的價值。並利用重要性與滿意度衡量當地民眾對於地區醫院所知覺到的醫療服務品質，藉此找到服務缺口，供地區醫院參考改進。 針對苗栗某地區之地區醫院的就醫病患及陪同病患的家屬做問卷調查研究。研究結果顯示，地區醫院與醫學中心相比，正確專業因素是地區醫院最迫切需改善的地方。醫療服務品質中的關懷親切因素、及時處理因素以及正確專業因素對於知覺價值有著顯著正向影響。醫院熟悉度與地理可近性的提升，皆能提升地區醫院對民眾的知覺價值。地理可近性會削弱正確專業品質對於知覺價值的正向影響，醫院熟悉度會削弱正確專業品質及及時處理品質對於知覺價值的正向影響。代表民眾會因為地理可近性，提高地區醫院在民眾心中的價值，對於較不易觸及的醫學中心反而打了折扣。也因為地理可近性的提高，造成民眾「有比沒有好」的心態，提高民眾對於正確專業品質的容忍度，從而降低正確專業品質對於知覺價值的正向影響。而醫院熟悉度提升會使民眾因為習慣而忽略其他因素，也因其對醫院的情感連結，使民眾對於正確專業品質與及時處理品質的容忍範圍較大，降低其對知覺價值之正向影響。[[abstract]]Since the start of the National health insurance in Taiwan in 1994, it had brought down the medical expense. The concentration of people in large hospitals has made small hospitals face many challenges. The value and purpose of local community hospitals are to improve medical fairness, increase mediacl accessibility and safeguard people’s right to medical care. In particular, rural areas with insufficient medical resources are more necessary for their existence. The government has implemented many subsidy policies and medical policies in hopes that medical resources can be distributes more fairly. The management strategy of the local community hospital is also a key to success or failure. Many studies use the medical services quality and perceived value and satisfaction to explore people's willingness to seek medical care. This study use medical service quality, perceptual value, TPB(Theory of Planned Behavior) and IPA (Importance-Performance Analysis) try to understand the role of geographic accessibility and familiarity of hospital. This study will enable government agencies and rural medical institutions to understand the value of medical institutions in areas with limited medical resources. Finally, this study use the importance and satisfaction to measure medical service quality that percept by people who had medical treatment and find service gaps to improve medical service quality. The study explored patient, family members and patient’s friend of local community hospitals at Miaoli by questionnaire. The results of the study show that correct-professional factor is the most pressing areas for improvement in local community hospital. Care-loving factor, timely processing factor, and correct-professional factor have a significant positive impact on perceived value. The geographic accessibility and familiarity of hospital have a significant positive impact on perceived value. Geographic accessibility moderates the relationship between correct-professional factor and perceived value. Familiarity of hospital moderates the relationship between correct-professional factor, timely processing factor and perceived value.[[note]]碩