臺灣博碩士論文加值系統

隨著近年來社會的改變，經濟的快速成長，GNP與國人教育程度的提升，顧客對於醫院及診所所提供之服務品質的需求與期望也越來越高。消費者期望醫院和診所能夠提供更好的醫療環境、醫療設備及醫療品質。因此，若醫院及診所能提升其服務品質，將能滿足顧客的需求，進而創造更好的績效。另外，透過與病患及其家屬的有效溝通與資訊分享，也能夠降低醫療糾紛發生的機率，並提高顧客的滿意度，進而提昇醫院的績效。
此篇研究的主要目的為探討當醫師面臨環境不確定性、病人行為不確定性及醫療結果不確定性時，他們的交易成本知覺將會提高，如果他們曾有過醫療糾紛經驗，將更加強他們的交易成本知覺。為了降低醫療風險的機率，他們將採行三種醫療行為，包括防禦性的醫療行為、提升服務品質及加強與病人間的溝通。其中，透過提升服務品質及加強與病人間的溝通可以提升醫師的績效，防禦性的醫療行為卻對績效沒有直接的效果影響。另外，醫療糾紛經驗(醫療糾紛頻率與病人嚴重程度)將會直接影響醫師的交易成本知覺，進而影響醫師所會採取的醫療行為，即醫療糾紛經驗並非直接影響醫師的醫療行為，此為一中介效果。

The main purpose of this study is to investigate that when physicians face environment uncertainty, patients’ behavior uncertainty, and medical outcome uncertainty, they will perceive higher level of transaction cost. If physicians have medical malpractice experience, it may reinforce the transaction cost perception of physicians. In such situation, physicians may adopt defensive medicine, but the way is not good for patients. Therefore, physicians may take more positive way such as improving the relationship with patients. When physicians improve their service quality and reinforce communication with patients, physicians will attract more patients and get better performance. On the other hand, treating behavior belongs to the high-contact service, physicians may incline to offer higher service quality to their patients.
Moreover, this research suggests that medical malpractice experience of physicians affect physicians’ treating behavior indirectly. It will raise physicians’ perception of transaction cost first, and then physicians will change their behavior to decrease their risk perception, such as adopting defensive medicine, improving service quality, or reinforcing communication with their patients.

DISSERTATION ABSTRACT i
CHINESE ABSTRACT v
ENGLISH ABSTRACT vi
ACKNOWLEDGEMENT vii
TABLE OF CONTENTS viii
LIST OF TABLES x
LIST OF FIGURES xi
1. INTRODUCTION 1
1.1 Background 1
1.2 Research Motivation and Objectives 3
1.3 Research structure 5
2. LITERATURE REVIEW 6
2.1 Transaction Costs Analysis 6
2.2 Medical Malpractice and Defensive Medicine 11
2.3 Service Quality 18
2.4 Communication in Physician-Patient Relationship 25
3. METHODOLOGY 29
3.1 Research Framework 29
3.2 Variable Measurement 30
3.3 Questionnaire Design 33
3.4 Sampling Design and Data Collection 33
3.5 Sample Analysis 36
3.6 Analytic Methods 40
4. DATA ANALYSES 41
4.1 Reliability and Validity 41
4.2 Structural Modeling Analysis 46
4.3 Hypotheses Testing 57
5. CONCLUSIONS AND SUGGESTIONS 58
5.1 Conclusions 58
5.2 Managerial Implication 60
5.3 Limitation and Future Research 62
REFERENCE 64
APPENDIX 76

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