Research on Grass-roots Clinics Customers’ Medical Factors in Metropolitan Areas of Northern Taiwan

臺灣自1995 年開始實施全民健保,20年來慢性的改變了臺灣醫療版圖。醫療的四大主科:內外婦兒,因為給付不合理與高醫療糾紛,使得醫療人才往低醫糾的科別移動,或離開醫院進入相對單純的基層診所。基層診所的數量大增,近十年增長近 20%,更驚人的超越全台便利商店量,使得診所進入紅海競爭的廝殺戰場。因此在這強烈的競爭下，診所的營運如何維持優勢，而在其中勝出，是本論文的研究重點。 傳統的醫療是屬於權威式的，醫師具有崇高的神話地位，客戶的遵從度高。但隨著教育水準的提升，醫療生態的改變，醫療產業漸漸轉型為服務業。服務業必須考慮顧客的需求與偏好，服務品質的提升，顧客滿意度與忠誠度，因為這些正向回饋至產業的經營業績。因此本研究將客戶的需求分兩個方向探討，一是初次看診病患，探究初診患者考量的因素，另一為複診病患，此類顧客回診的考量是什麼，並進一步調查診察後病患的滿意度與忠誠度。我們以臺灣北部都會地區某基層診所的病患為母體，實施問卷調查，而為了讓研究的抽樣不偏頗，我們採用分層隨機抽樣，先選擇實施研究的時段，依照看診科別的不同，醫師時段的不同，病患上下班時間的差異來平均抽樣的診次。而後我們設計了問卷，經過效度的討論分析修正，再開始正式實施問卷。有效問卷比例為56.9%，再進入敘述性統計，交叉分析與集群分析。研究結果發現，不論是初複診病患，交通便利性皆是選擇診所很重要的原因。因此診所的設置可以先參考人口分佈狀況，選擇人群集中的市集、群落為主，以半徑500公尺找出圓心，即為良好的地點。而後續如何維持舊客戶的回流與開發新客源，就需探討複診顧客在乎的就診因素與忠誠度的建立。複診病患的就醫考量中，醫師的特性（信任醫師的專業能力）是最重要的因素，其次是醫療服務品質。所以醫師本身需強化自身專業領域，不斷進修，吸收新知，才能造福患者。而診所的服務品質，客戶較重視的是醫護人員的技術能力（可靠性），醫護人員的親切服務（關懷性），環境的舒適整潔（有形性），與就醫流程的順暢（可靠性）。至於顧客的忠誠度,除了影響回客率,也是良好的宣傳者,可形成診所的口碑與開發新客源。研究結果發現,加強診所半徑 500 公尺的顧客黏著性,是穩定客源最好的方法。而小兒科比耳鼻喉科的忠誠度高,顯示從嬰幼兒預防保健到學齡前,學齡後的疾病診治,長期的感情基礎是忠誠度的基石,因此疫苗注射的供應或許是提升忠誠度一個重要環節。此外,從集群分析我們發現,強化醫師專業能力、醫護人員的技術與能力、就醫流程的順暢這三項醫療服務品質,亦可以提升顧客忠誠度。 總結來說，在臺灣北部都會型地區競爭激烈的基層診所，一開始地點的選擇決定了成敗與否的重要因素，而後續如何吸引新顧客，留住舊客戶，建立病患忠誠度，是診所維持營運的重要考慮，而其中最重要的關鍵還是醫師專業能力與良好的醫療服務品質，這才是診所經營的王道。在結論之外，我們論文尚有不足之處，首先因為受測者為病患，問卷的設計應更簡化易填。再者必須依據年齡變數分開定義就醫頻率來追蹤忠誠度，因為不同年齡的就醫需求是不同的。另外本研究的抽樣數量太少，若需要更精確的可信度，應擴大研究規模，甚至擴展到不同診所的比較或至醫院層級。可以有更大的研究資料。Taiwan began to implement universal health insurance in 1995 and changed the medical territory chronically over the past 20 years. There are four main medical subjects: internal medicine, surgery, gynecology and pediatrics. Because of the unreasonable payment and high medical dispute, medical personnel have moved to low medical dispute departments or left the hospital to enter the relatively simple grass-roots clinics. The number of grass-roots clinics has increased big. It has an increase of nearly 20 percent in the last ten years. It is amazing that it has surpassed the amount of convenience stores in Taiwan, which has turned clinics into battlefields for the Red Sea competition. Therefore, it is the research focus of this study to learn how to maintain the advantages of clinics and emerge as leaders in this intense competition. In tradition, the field of medical practice is authoritative in which doctors have noble status and customers have high compliance. With the improving education standards and the changing medical ecosystem, the medical industry has gradually transformed into service industry. Customer needs and preferences, service quality improvement, customer satisfaction and loyalty all need to be considered, as these can impact the operating performance of the industry. This study will explore customer needs in two different directions, one is the factors for consideration for first-visit patient while the other is the factors for consideration for the subsequent-visit patient, and further analyzing the satisfaction and loyalty of patients after visit. We take the patients from a clinic in metropolitan area of Northern Taiwan as a population and conduct survey. To make the research results unbiased, we use stratified random sampling and take the average number of visits based on different medical practice fields, different doctors'' working hours and the time that patients going to and getting off from work. Then, we design a questionnaire and start conducting survey after discussion, analysis and correction of validity. There are 56.9% of valid questionnaire results which are put through descriptive statistics, cross and cluster analysis. The study finds that the convenience in transportation is an important factor for selecting clinics no matter if it''s for the first-visit or subsequent-visit. Therefore, the selection of clinic’s location should consider first the population distribution, focusing on marketplace and community with crowds and finding a center point with a radius of 500 meters, and that will be an ideal location. The subsequent measures in maintaining existing customers’ reflux and finding new customers will rely on exploring the reasons for visit for the returning customers and the building loyalty. The subsequent-visit patients consider the characteristics of doctors (trusting their expertise) the most important factor, followed by the medical service quality. Therefore, doctors need to improve their professional field, constantly learning to care for patients. As for the service quality of clinics, customers are more concerned about the staff techniques (reliability), staff friendliness (caring), clean and comfortable environment (tangibility) and smooth treatment process (reliability). Customer loyalty, in addition to affecting the back-off rate, can be a good publicity to form the reputation of the clinic and bring in new customers. The results of the study show that, the best way to stabilize a customer source is to strengthen customer adhesion within a radius of 500 meters of clinics. The loyalty for pediatrics is higher than that for otolaryngology, showing that the preventive care from infant stage to preschool, the diagnosis and treatment during school age and long-term emotional foundation are the cornerstones of loyalty, so that the supply of vaccine may be an important factor in improving loyalty. In addition, we find that from the cluster analysis, the three medical service quality of enhancing doctors'' professional capacity, medical workers’ techniques and abilities and the smoothness of visit process can also improve the customer loyalty. In conclusion, for the basic clinics located in Northern Taiwan''s highly competitive metropolitan area, the selection of location can be an important factor deciding success or failure at the beginning. Attracting new customers, retaining old customers and building loyalty are the important considerations for clinics to maintaining operation. The keys are still the professional capacity of doctors and the excellent medical service quality, both the principles in managing clinics. In addition to this conclusion, we find more room for improvement for this study because the survey-takers are the patients so the questionnaire design should be further simplified for easier completion. Furthermore, loyalty needs to be tracked based on age variable to separately define the visit frequency because the needs for clinic visit are different for different ages. Also, the number of samples in this study may be too few that the more precise credibility can be achieved by expanding the scale of research to different clinics or even hospitals, obtaining more research data