| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 95 === The competition between medical facilities became more intense after global budget. Every special section under the health insurance reimbursement were all in the storm, including hemodialysis. The competition with other medical facilities was not only for a profit but also for a simple purpose of survival. Many strategies of increasing competitiveness had been suggested, such as continuous improvement of quality, cost leadership, product differentiation, product focus, efficiency management, emphasizing customer service, innovation, searching target market, and developing a marketing mix from customers need. All of the above strategies were effective and could be controlled by oneself. However, all of the above strategies must be based on the need of customes. Unfortunately, the expectations of patients usually differed from the recognition of medical specialists on the topic of medical quality. The characteristic of patients on hemodialysis was also different from that of patients calling for general outpatient department. The values also changed from day to day. It is an important and simple method to find out the strategy to increase the competitiveness of dialysis facilities from the viewpoint of the needs of patients. It is also our aims to design this study. After the factors affecting the decision of selecting facilities in hemodialysis patients are figured out, the limited resourced can be focused on the items which patients considered as the most important. Then the style and function of the facility will be differentiated from those of others and the cost can be reduced. The market segmentation and the following concentration approach allow a facility to specialize and focus all its efforts on the special market segment. These accelerate cooperation between hemodialysis facilities and reduce the risk of vicious competition.
The patients, family members, doctors, and nurses in Taipei city and county were investigated with a structured, closed and self-designed questionnaire, which was confirmed by specialist validity and Kuder-Richardson reliability（Cronbach Coefficient Alpha: 0.858）. The samples were collected randomly and all these data were primary. Total 786 questionnaires were delivered, and 663 questionnaires were retrieved. Only 636 questionnaires were effective and the effective data collection rate was 81%. There were 492 patients, 48 family members, 31 doctors, and 65 nurses totally.
The result revealed that dialysis patients were older with an average age of 61 years and half the patients were male. The most had a level of elementary school education, following by junior collage and senior high school. About 80% were jobless. The most dialysis age was 1~3 years and the following was 3~5 years. The frequency of hemodialysis was thrice per week mostly. The strongest demographic factors affecting the decision of selecting facilities were the level of education, conveyance, and the presence of other chronic diseases. Whoever put the strongest emphasis on the performance quality of dialysis and the least emphasis on the “free of registry fee”, “expense”,“connecting service by conveyance of facilities”, and“nutrition allowance from facilities”. Factor analysis extracted seven common factors from these 33 consideration factors and their priority were as follows：“efficacy of medical personnel”, “Performance quality of dialysis”, “comprehensiveness of healthcare services”, “cost of seeking care”, “access”, “satisfaction of others”, “value of resources”. The importance of “traffic convenience”was fair from viewpoint of patients, but it was over-emphasis from the viewpoint of medical personnel. However, dialysis patients as well as the general patients paid much attention to medical skills of doctors, and the service attitude of medical personnel.
Although the treatment of hemodialysis was almost standardized and mature, patients still considered medical skills before the service attitude. It was apparent that reinforcement of medical skills was a top priority even though the service attitude was also very important. No dialysis patients will be attracted by means of perfect service attitude without reinforcement of medical skills in Taipei city and county. All other marketing methods contribute little to dialysis facilities for so rational patients.
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