臺灣博碩士論文加值系統

雷射及脈衝光為最受大眾歡迎的二種美容治療。有愈來愈多醫師，不論其訓練背景為何，相繼投入有利可圖的美容服務，實乃因為目前對醫師從事相關業務無法可管。本研究的目的，在試圖找出不同專科的醫師在美容區塊的優劣勢。利用因素分析，我們從十九項選擇醫師時考量因素中，粹取出其中主要決定因素。再利用層級分析法，計算出各主要決定因素的相對權重，以及皮膚科、整型外科和美容科醫師在各主要決定因素的相對優劣勢。受訪者在閱讀皮膚科、整型外科醫師訓練綱要後，再次勾選上述三科的相對表現。結果顯示醫療專業性(0.3296)為最重要的主要決定因素，緊接在後的分別是推薦聲譽性(0.2198)、醫療友善性(0.1350)、成本便利性(0.1307)、附帶性醫療服務(0.0984)及醫師個別差異性(0.0865)。其中皮膚科除了在為整型外科強項的附帶性醫療服務外，均佔有優勢。此外研究也發現，年齡在四十歲以下、具大專學歷、每月可動用金額在貳萬臺幣以下的新病患較容易受外來訊息影響，改變其對醫師的評價。在本研究中，則傾向提高對皮膚科醫師的評價。

Cutaneous laser and intense pulsed light treatments are two of the most popular aesthetic treatment modalities. More and more physicians regardless of their training background are providing such profitable services because there is still no regulation on the cosmetic procedures a physician can perform. The purpose of the present study was to find out the relative strength and weakness of different medical specialties in providing laser and intense pulsed light treatment. Major decision factors for physician selection were extracted from 19 physician choice criteria with factor analysis. Using analytic hierarchy process, the relative weight of these factors and that of dermatologists, plastic surgeons and aesthetic practitioners in each factor were calculated. After reading the training curricula of dermatologists and plastic surgeons, respondents were asked to rate again the 3 medical specialties. Our results indicated that medical competence (0.3296) was the most important major decision factor followed by recommendation (0.2198), friendliness (0.1350), cost (0.1307), complete service (0.0984) and physical attribute of the physician (0.0865). Compared with plastic surgeons and aesthetic practitioners, dermatologists had an advantage in all factors except complete service, which was the strength of plastic surgeons. New patients, aged under 40, with a college degree and a monthly allowance less than 20000 NTD were more likely to change their rating in favor of dermatologists after reading the curriculum profile..

ABSTRACT i
TABLE OF CONTENTS iv
LIST OF TABLES vi
LIST OF FIGURES ix
CHAPTER 1 INTRODUCTION
1.1 Research Background 1
1.2 Research Purposes 3
1.3 Research Process 4
CHAPTER 2 LITERATURE REVIEW
2.1 Physician Choice Criteria 7
2.2 Interdisciplinary Cooperation and Competition 9
2.3 Bounded Rationality in Health Care Decision 11
2.4 Cosmetic Laser and Intense Pulsed Light Treatment 12
CHAPTER 3 METHODOLOGY
3.1 Factor Analysis 15
3.2 Analytic Hierarchy Process 17
3.2.1 Analytic Hierarchy Process in Medical Issues 20
CHAPTER 4 RESEARCH DESIGN
4.1 Major Decision Factors in Physician Selection 21
4.2 Hierarchy Structure for Physician Selection 22
4.3 Statistic Analysis 27
CHAPTER 5 RESULTS
5.1 Exploratory Principal Factor Analysis 29
5.1.1 The Importance of Each Choice Criterion 29
5.1.2 Internal Consistency and Item Reduction 30
5.1.3 Definitions of Major Decision Factors 31
5.1.4 Summary of Factor Analysis 32
5.2 Analytic Hierarchy Process 32
5.2.1 Analysis of Relative Importance of 6 Major Decision Factors 32
5.2.2 Analysis of Medical Specialties 38
5.2.3 The Effect of Information Disclosure 48
5.2.4 Summary of Analytic Hierarchy Process 54
CHAPTER 6 DISCUSSION AND CONCLUSION
6.1 Discussion 56
6.2 Conclusion 61
6.3 Research limitations 62
6.3.1 Major Decision Factors 62
6.3.2 Individual Variation 62
6.3.3 Location Concerns 62
6.3.4 Cultural Concerns 63
6.4 Implication 63
REFERENCES 64
ACKNOWLEDGMENT 69
APPENDIX 70
Appendix 1 70
Appendix 2 72

REFERENCES

Bauer, A., Greif, C., Vollandt, R., Merker, A., and Elsner, P. 1999. Vulval diseases needed an interdisciplinary approach. Clinical and Laboratory Investigations, 199:223-226.

Bjerring, P., Christiansen, K., Troilius, A., and Dierickx, C. 2004. Facial photo rejuvenation using two different intense pulsed light (IPL) wavelength bands. Lasers in Surgery and Medicine, 34:120-126.

Boscarino, J., and Steiber, S.R. 1982. Hospital shopping and consumer choice. Journal of Health Care Marketing, 2:15-23.

Cheng, S.H., and Song, H.Y. 2004. Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors. Quality & Safety in Health Care, 13:98-101.

Conlisk, J. 1996. Why bounded rationality? Journal of Economic Literature, 34:669-700.

Conway, J.M., and Huffcutt, A.I. 2003. A review and evaluation of exploratory factor analysis practices in organizational research. Organizational Research Methods, 6:147-168.

Crane, F.G., and Lynch, J.E. 1988. Consumer selection of physicians and dentists: an examination of choice criteria and cue usage. Journal of Health Care Marketing, 8:16-19.

Cronenwett, J.L. 2004. Vascular surgery training in the United States, 1994 to 2003. Journal of Vascular Surgery, 40:660-669.

Dolan, J.G., Bordley, D.R., Miller, H. 1993. Diagnostic strategies in the management of acute upper gastrointestinal bleeding: Patient and physician preferences, Journal of General Internal Medicine, 8:525-529.

Fabrigar, L.R., Wegener, D.T., MacCullum, R.C., and Strahan, E.J. 1999. Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4:272-299.
Ford, J.K., MacCullum, R.C., and Tait, M. 1986. The application of exploratory factor analysis in applied psychology: A critical review and analysis. Personnel Psychology, 39:291-314.

Forman, E.H., and Gass, S.I. 2001. The analytic hierarchy process – an exposition. Operations Research, 49:469-486.

Glassman, M. and Glassman, N. 1981. A marketing analysis of physician selection and patient satisfaction. Journal of Health Care Marketing, 1:25-31.

Gochman, D.S., Studenborg, G.J., and Feler, A. 1985. The ideal physician: Implications for contemporary hospital marketing. Journal of Health Care Marketing, 6:17-25.

Greer, S.E. 2001. A lesson from the high-tech economic boom: Use the competitive advantage of plastic surgery. Plastic and Reconstructive Surgery. 107:598-601.

Hanna, N., Schoenbachler, D.D., and Gordon, G.L. 1994. Physician choice criteria: Factors influencing patient selection of generalists versus specialists. Health Marketing Quarterly, 12:29-42.

Harker, P.T., and Varga, L.G. 1987. The theory of ratio scale estimation: Saaty''s analytic hierarchy process. Management Science, 33:1383-1403.

Hill, C.J. 1991. Factors influencing physician choice. Hospital and Health Services Administration, 36:491-503.

Jackson, B.A. 2003. Laser in ethnic skin: a review. Journal of the American Academy of Dermatology, 48:S134-138.

Javalgi, R.G., Rao, S.R., and Thomas, E.G. 1991. Choosing a hospital: analysis of consumer tradeoffs. Journal of Health Care Marketing, 11:12-22.

Kane, R.L., Olsen, D.M., Newman, J., and Manson, J. 1978. Giving and getting surgery in Utah: an urban-rural comparison. Surgery, 83:375-381.

Kasteler, J., Kane, R.L., Olson, D.M., and Thetford, C. 1976. Issues underlying prevalence of ‘doctor-shopping’ behavior. Journal of Health Behavior, 17:328-339.

Krieger, L.M. 2002. Discount cosmetic surgery: Industry trends and strategies for success. Plastic and Reconstructive Surgery, 110:614-619.

Kurz, R.S., and Wolinsky, F.D. 1985. Who picks the hospital: Practitioner or patient? Hospital and Health Services Administration, 30:95-106.

Kushikata. N., Negishi, K., Tezuka, Y., Takeuchi, K., and Wakamatsu, S. 2005. Non-ablative skin tightening with radiofrequency in Asian skin. Lasers in Surgery and Medicine, 36:92-97.

Kwiesielewicz, M., and van Uden, E. 2004. Inconsistent and contradictory judgements in pairwise comparison methods in the AHP. Computers & Operations Research 31:713-719.

Lamb, C.W., Hoverstad, R., and Lancaster, W. 1988. Consumer perceptions about doctors of osteopathy and medical doctors. Journal of Health Care Marketing, 8:53-57.

Legrand, J.J. 2004. Aesthetic medicine: a booming medical activity. Journal of Cosmetic Dermatology, 2:1.

MacCullum, R.C., Widaman, K.F., Zhang, S., and Hong, S. 1999. Sample size in factor analysis. Psychological Methods, 4:84-99.

MacStravic, R.C. 1987. Manageable evidence in medical care marketing. Journal of Health Care Marketing, 7:5-59.

Markey, A.C. 2004. Dermatologists and cosmetic surgery − a personal view of regulation and training issues. Clinical and Experimental Dermatology, 29:690-692.

Miller, S. 1998. Competitive forces and academic plastic surgery. Plastic and Reconstructive Surgery, 101:1389-1399.

Nowak, L.I., and Washburn, J.H. 1998. Patient sources of information and decision factors in selecting cosmetic surgeons. Health Marketing Quarterly, 15:45-54.

Pohlmann, J.T. 2004. Use and interpretation of factor analysis in the journal of educational research: 1992-2002. Journal of Educational Research, 98:14-22.
Saaty, T.L. 1980. The analytic hierarchy process. New York: McGraw-Hill Book Company.

Saaty, T.L. 1990. How to make a decision: the analytic hierarchy process. European Journal of Operational Research, 48:9-26.

Satty, T.L. 1994. How to make a decision: the analytic hierarchy process. Interfaces, 24:19-43.

Schleff, T., and Schaffer, M. 1987. How do consumers select physicians? Medical Group Management, May-June:32-36.

Schmittdiel, J., Selby, J.V., Grumbach, K., and Quesenberry, C.P. 1997. Choice of a personal physician and patient satisfaction in a health maintenance organization. Journal of the American Medical Association, 278:1596-1599.

Stewart, D.W., Hickson, G.B., Pechmann, C., Roslow, S., and Altemeier, W.A. 1989. Information search and decision making in the selection of family health care. Journal of Health Care Marketing, 9:29-39.

Tanzi, E.L., Lupton, J.R., and Alster, T.S. 2003. Lasers in dermatology: Four decades of progress. Journal of the American Academy of Dermatology, 49:1-31.

Taylor, S.L., and Capella, L.M. 1996. Hospital outshopping: determinant attributes and hospital choice. Health Care Management Review, 21:33-44.

Thurstone, L.L. 1947. Multiple factor analysis: a development and expansion of the vectors of mind. Chicago: University of Chicago Press.

Tsai, C.T. 2004. Consumers’ behavioral intention on cosmetic laser surgery − Application of structure equation model. Matser’s thesis, College of Management, National Chung-Cheng Univeristy, Chiayi, Taiwan. (in Chinese)

Wang, N.P. 1999a. The application of analytic hierarchy process in the selection of hospital. Chinese Journal of Public Health, 18:138-151. (in Chinese)

Wang, N.P. 1999b. The study of consumers'' preference for hospitals − Application of AHP. Journal of Management, 16:661-681. (in Chinese)

Wu, T.C. 2001. Consumer behavior of skin laser therapy − a case study on surgical patients of a community hospital in Taichung. Master’s thesis, Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan. (in Chinese)