臺灣博碩士論文加值系統

自從全民健保實施以來，台灣的醫療狀況巨變，醫療產業面臨極大的挑戰。一般民眾對於唾手可得的診療機會，往往不知愛惜醫療資源，總是有著〝逛醫院〞的型態產生。然而醫院產業朝向規模大型化的發展趨勢，民眾可以依照自由意志選擇就醫之醫療院所，也造成醫療院所之間的彼此競爭。
在這激烈的競爭環境之下，醫療院所必須採取許多模式來改變醫療產業的生存。但基於醫療法規與政府的督導之下，醫院是無法徹底的與一般企業一樣，有著廣告宣傳、海報…等等的行銷手法。因此，在以病患為導向之驅動下，醫療評鑑越來越受到重視。再加上，健保的財務緊縮，國內醫院生存不易，若可以取得國際認證，將有助吸引外國病患，甚至可申請國外保險機構給付，跳脫出競爭激烈的國內環境，開拓一片新的藍海市場。
本研究的標的醫院為台灣的龍頭醫院，將於今年4月接受國際醫療評鑑，想藉由JCI國際醫療評鑑來幫助醫院檢視並完備各項作業政策與流程、提供安全與有保障的就醫環境、落實以病人為中心的理念、塑造有品質的醫院文化、提升醫院醫療與服務品質，與國際醫療接軌，期望能提升病患對醫院的評價，且能使患者享受到最佳的就醫品質。
因此，本研究為台灣龍頭為例，探索病人對於國際醫療評鑑項目的認知和主觀的醫療服務品質是否有所關聯性。本研究將JCI國際醫療評鑑項目分為三大構面，分別是醫療環境、醫療人員、及醫療服務，且和醫療服務品質滿意度進行關聯性的比較；研究對象為醫院的門診病人；研究工具則為問卷加訪談。研究結果可以看出，(1)醫療環境與醫療服務品質滿意度是有關聯性的；(2)醫療人員與醫療服務品質滿意度是有關聯性的；(3)醫療服務與醫療服務品質滿意度是有關聯性的。
藉由本研究的建議，醫院參與國際醫療評鑑，是可以提升更高的醫療品質，但是須注意的是，如何保持好的醫療服務品質，真正了解病患的需求，提供病患所需要的醫療服務，才是醫院的需要重視的部份。

Summary
Since the National Health Insurance (NIH) began to put into practice, the medical situations in Taiwan have changed greatly. The medical business faced the tremendous challenges. Owning to the convenience of getting treatment, people tend to waste the medical resources and regard hospitals as “absolutely free shopping mall”. However, the scale of hospital business becomes more and more huge. People with their free will can choose the proper hospitals; therefore, it creates competition among hospitals.
Under such circumstance, many hospitals have to carry out many ways to keep the survival of medical business. It’s the medical regulations and observation of government that hospitals can not compare with enterprises, which have commercial advertisements and posters as their marketing strategies. As a result, people pay more attention to JCIA due to the patient- oriented force. In addition, the shortage of the financial supports to NIH that creates difficult situation to hospitals in Taiwan. If hospitals in Taiwan acquire some international certifications, which may attract foreign patients and even help those hospitals apply medical fee from overseas insurance institutes. By doing so, some hospitals in Taiwan can jump out of the crowded and competitive market and find brand new and broad market out of Taiwan.
The hospital taken as research object in this paper is the head of hospitals in Taiwan. This hospital was evaluated by JCI this April, and the hospital intended to use the accreditation by JCI to observe and organize the medical policies and operations. The hospital, with patients as the top priority bear in minds, hopes to offer save and guaranteed medical surroundings, sets up high quality hospital culture, and elevates the treatments and quality of medical service as well. The hospital also hopes to connect with the international medical services, and to elevate patients’ comments to hospital. Patients can benefit from the high quality of medical services.
As a result, take the head of hospitals in Taiwan for example, this paper is finding out if there are any connections between patients’ understanding on items of JCIA and subjective feelings to quality of medical service. This research paper separates the evaluation items of JCI into three parts, and each is that medical surroundings, medical staffs, and related comparison between the quality of medical services and patients’ satisfaction to it. The research objects are patients in this hospital; the research tools are questionnaires and interview. From the results of the research, I can conclude that (1) the satisfaction to quality of medical services has to do with medical surroundings; (2) there are connections between medical staffs and satisfactions to quality of medical services; (3) there are connections between medical services and satisfactions to quality of medical services.
With the suggestion of this research, hospitals accredited by JCI, which can help those hospitals elevate the quality of medical services. Last but not least, how to maintain the good quality of medical service, to realize the real needs of patients, and to offer the necessary medical services is what the hospitals should pay more attention to.

第摘要...............................................................I
ABSTRACT..........................................................II
目錄..............................................................III
圖目錄............................................................V
表目錄............................................................VI
第一章 緒論.......................................................1
第一節 研究動機................................................1
第二節 研究目的................................................1
第三節 研究架構與研究流程......................................2
第二章 文獻探討...................................................3
第一節 國內外醫院評鑑沿革與發展................................3
第二節 美國醫療衛生機構認證...................................12
第三節 醫療服務品質...........................................21
第四節 病患滿意度.............................................31
第三章 研究方法與研究設計........................................34
第一節 研究架構...............................................34
第二節 研究命題...............................................36
第三節 問卷設計...............................................37
第四節 研究設計...............................................38
第四章 研究結果..................................................40
第一節 醫療環境與醫療服務品質滿意度之分析.....................40
第二節 醫療人員與醫療服務品質滿意度之分析.....................43
第三節 醫療服務與醫療服務品質滿意度之分析.....................46
第五章 結論與建議................................................52
第一節 結論...................................................52
第二節 研究限制...............................................52
第三節 研究建議...............................................53
參考文獻..........................................................55
中文部份.......................................................55
英文部分.......................................................56
附錄..............................................................60
附錄一 問卷....................................................60
附錄二 訪談摘要記錄............................................63

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