| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 94 === Abstract
Objective
Under the pressure of high rate increase of medical expenditure the Taiwan''s National Health Insurance (NHI) system has launched the “NHI family physician integrated delivery system” since 2003, to change the public seeking medical treatment behavior. Nevertheless, few studies have been dedicated to the understanding of what are the predicting factors for public medical service satisfactory and loyalty of patients to their family physician The purposes of this study were to understand the outcome variables included cognition level of the family physician service plan. Covariates included quality and expectation toward medical service and will further study the public level of medical service perceived satisfaction and their medical seeking behavior such as loyalty. Using these factors to build a model to evaluate the predictability of significant predicting factors for public medical service satisfactory and loyalty, so as to help the family physician to upgrade their quality of service. satisfaction with care and ease of service use.
Methods:
This study used experimental like design models, and use structural questionnaires to investigate. The research start from January 20th, 2006 till 28th February. Random sample of public, who were member of five of the community medical groups of Ping Tung as the enrollees for the experimental group. Patients who did not join in as enrollees as the control group. The questionnaires were reviewed by five specialists and has a Cronbach alpha 0.9. The test were done at 24 primary care clinic and questionnaires were filled by patients themselves. Their name were not written. A total of 1400 questionnaires were distributed, and a total of 1229 questionnaires returned, a return rate of 88% . 688 questionnaires for the experimental group and 541 questionnaires for the control group, chi square test for the basic data for the two group show no significant difference (p>0.05).
Data analysis by SPSS for Windows 10.0 for descriptive analysis and statistical test ..
Results:
Experimental group and control group patients’ level of cognition toward the “NHI family physician plan” service content show significant different. (t=22.69, p=0.00)
The first three items that patients expect for service quality are doctor correct diagnosis (4.58); second is medical ethic and take care of patients(4.55); third was explain patients illness in detail (4.53), experimental group expectation for service quality was higher than the control group show significant difference. (t=6.99, p=0.00).
The first three items that public satisfaction with care and services from their family physician medical service are first: medical technique (4.07), attitude when treating patient (4.07), explanation of illness (3.99); and the most dissatisfaction are consultation fee and partial payment (3.49), and the 24 hours telephone consultation (3.77). This study found that the level of satisfaction for member of the family doctor was higher than those who were not and significant different. (t=11.66, p=0.00)
From the study concern public loyalty to their primary care physicians, that the public willing to return to the original clinic to seek medical service had score an average of 4.11. This showed that public choice for primary care clinic are more prone to high loyalty. Compared the loyalty of patients toward their family physician, the experimental group are significantly higher than the control group. (t=12.85, p=0.00)
The cognition and expectation quality for the experimental group and control group (Pearson’s r=.16**), medical treatment satisfaction (r=.39**) and loyalty (r=.43**), showed significant correlation, the loyalty and medical service satisfaction correlation show significant correlation(Pearson’s r=.50, p=0.000).
The relative factors that have predicting influence on medical service satisfaction were: 1. Relative factor that affect medical service satisfaction are: understanding about family physician plan, quality of service expectation, age, other specialist, member of family physician and occupation as the 8 co-factors can explained 27.8% of variate volume. understanding about family physician plan and quality of service expectation stand the largest explaination varian of 26.5%,29.3%. More elderly age, and joining as member of the family physician also increased the medical service satisfaction.
The relative factors that have predicting influence on medical seeking loyalty were: 1. Relative factor that affect medical seeking loyalty are: understanding about family physician plan, quality of service expectation, member of family physician ,medical seeking beyond area, age, internal medical as the 6 co-factors can explained medical seeking loyalty 25.6% of total variate . understanding about family physician plan alone has an explaination strength of 33.1. More elderly age and joining as member of the family physician all increase level of medical seeking loyalty.
Conclusions and Suggestions
The aim of family physician integrated deliver system is to hope that the public will receive an integrated primary care and preventive health service. To ensure also the continuous patient care from clinic to hospital if referral is needed. This will save their time to seek for medical treatment every where, money and medical expenses .
This study found that most public still seek medical service from the primary care clinic. Theirs expectation were very high for quality of medical service and the higher the medical service satisfaction the higher were their loyalty. we suggest that primary care physician should improve their quality of medical service and specialist ability, thus improve their medical service satisfaction and public trust towards primary care clinic. Also through building good patient-physician relationship, provide a continuous and integrated care to ensure graded medical care, bi-directional transfer system and family physician training program to be successful.
This study showed significant difference in cognition, expectation, satisfaction, loyalty to physician between the experimental group and control group. Show that those join as member of the experimental group enjoy more medical care satisfaction and more loyal to their own family physician clinic. But only 5% of those interviewed understand about the content of family physician project, seem too little. Thus we suggest to the NHI bureau to increase promotion of their policy, accompany with the payment system, cancer the upper limitation of 1000 members for each family physician, provide attractive incentives and encourage primary care clinic to join in the project , more active care of patient health and thus improve the public medical seeking behavior.
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