臺灣博碩士論文加值系統

自從軍人納入全民健保體系後，使得原先接受國軍醫療體系照護的軍人及軍中聘雇人員，不再侷限於軍方的醫療體系，而有更多的就醫選擇性。面對民間醫院的強力競爭，如何提升國軍醫院的經營管理，以留住軍人的回診意願，為一管理性問題，軍人是國軍醫院主要的主要顧客，國軍醫院也肩負照顧軍人醫療的主要任務，因此探究與分析國軍人員的再回診意願，可供國軍醫院作為營運方式與服務策略之參考。
本研究旨在探討國軍醫護人員專業能力、醫病溝通透過病患之信任，對再回診意願是否具有顯著的關連性，以及醫院形象對再回診之意願是否有影響。析言之，本研究主要研究的問題如下:
一、探討國軍醫護人員專業能力、醫病溝通與醫病信任的影響。
二、探討醫病信任、醫院形象（自變項）與再回診意願（依變項）之關聯性。
三、探討國軍醫病信任對醫療專業能力、醫病溝通與再回診意願之中介效果。
本研究針對後備指揮部官兵及聘僱人員共發出716份問卷，經過濾後有效問卷為600份，有效回收率為83.8%，並用LISREL8.72統計分析軟體進行假設模型的適配度檢定，排除遺漏項後納入結構方程模式(Structual Equation Modeling，SEM)分析計有樣本544人，藉由實證結果與分析，本研究六個假說: １.醫護人員之醫療專業能力正向影響國軍人員之醫病信任。２.醫師之醫病溝通能力正向影響國軍人員之醫病信任。３.國軍醫院形象正向影響國軍人員之再回診意願。４.國軍人員之醫病信任正向影響其再回診意願。５.「信任」為「醫療專業能力」與「再回診意願」之中介變數。６.「信任」為「醫病溝通」與「再回診意願」之中介變數。均獲得成立，表示「醫療專業能力」、「醫病溝通」、「醫院形象」、「醫病信任」及「再回診意願」各潛在變項間關係與測量均能透過實證資料獲得支持。
透過本研究實證資料支持，驗證醫療專業、醫病溝通、醫病信任與醫院形象，可有效共同影響病患再回診意願，其中最重要影響「再回診意願」的變數為「醫病信任」，而「醫療專業」及「醫病溝通｣為「醫病信任」的前置因子，因而本文最後從醫療專業、醫病溝通及醫院形象等三方面，提出提升病患再回診意願之政策性建議。

The soldier and military personnel hiring former military of receiving medical care system is no longer to limited to the military health care system，since the military has included the National Health Insurance System, there are more options for medical treatments; in contract to military hospitals, facing strong competition from private hospitals, the management and survival of military hospitals, also encountering strong challenges and pressures. The main military hospital customers are from the soldier, and taking medical care of the solider is also the main mission of military hospitals, therefore, the investigation and analysis of the military personnel’s revisit intention can provide operation modes and the service strategies to military hospitals.
　　The purpose of the research inquiry is to investigate revisit intention regarding to the professional capacity of the military health-care personnel, and doctor-patient communication through the patient's trust, whether or not with significant correlations，as well as the images of the hospital influence the aspiration for revisit intention; military hospitals as the main research objects，the questionnaires survey from the cadres & soldiers and contracted personnel of ROCAFRC as the issued focus．The following three main issues will be investigated:
1. Examine the relevance between the independent variables (the professional capacity of the military health-care personnel, the doctor-patient communication) and the dependent variable (the doctor-patient trust).
2. Explore the association of revisit intention (the dependent variable) and the healing trust & hospital images (independent variables).
3. Investigate the mediation effect between the military hospital trust in the independent variables (medical expertise, healing communication) and dependent variables (revisit intention).
After the questionnaires were issued 716, filtered by 600 valid questionnaires, the effective rate was 83.8%, and goodness of fit test assumptions of the model used LISREL8.72 statistical analysis software to exclude omissions included in the structural equation modeling (Structural Equation Modeling, SEM) analyzer has a sample of 544 people, with empirical results and analysis of this study six hypothesis: 1. medical expertise of physicians positive impact on the doctor-patient trust of the military personnel. 2. Doctor-patient communication skills with Physician positive impact on the doctor-patient trust 3. The images of military hospitals have the positive impact on the revisit intention of the soldiers. 4. The doctor-patient trust has the positive influence on the revisit intention. 5. "Trust" is the mediator variable of "medical expertise" and "revisit intention". 6. "Trust" is the mediator variable of "doctor-patient communication" and "revisit intention". All above hold, it means that each potential variables and measurements can be supported by empirical data through the relationship among "medical expertise" the doctor-patient communication", "the image of the hospital", "doctor-patient trust" and "revisit intention.”
Using empirical data to support this study and verify medical expertise, healing communication, healing trust, and hospital images that have combined impact on revisit intention effectively. The study validates that the most important variable to determine the patient’s revisiting intention is “healing trust”, both “medical profession” and “doctor-patient communication” are predisposing factors for “healing trust”. Thus, finally, from threes paths, medical profession, doctor-patient communication and hospital images, this study proposes policy recommendations on enhancing revisit intention.

目錄.....................................................I
圖目錄...................................................Ⅲ
表目錄...................................................Ⅳ
第一章 緒論
1.1 研究背景與動機........................................1
1.2 研究問題與目的........................................2
1.3 研究範圍與對象........................................2
1.4 章節安排.............................................3
第二章 文獻探討
2.1 醫療專業能力.........................................4
2.2 醫病溝通.............................................5
2.3 醫院形象.............................................7
2.4 醫病信任.............................................8
2.5 再回診意願...........................................10
2.6 醫療專業能力與醫病信任之關聯性.........................11
2.7 醫病溝通與醫病信任之關聯性.............................11
2.8 醫院形象與再回診意願關聯性.............................12
2.9 醫病信任與再回診意願關聯性.............................12
第三章 研究設計
3.1 研究架構.............................................14
3.2 變項定義與衡量方法....... ............................15
3.3 抽樣設計.............................................17
3.4 資料分析方法..........................................17
第四章 實證研究結果與分析
4.1 問卷回收及樣本分析.....................................19
4.2 問卷信效度分析........................................20
4.2.1 信度的分析..........................................20
4.2.2 效度的分析..........................................21
4.3 各構面之相關係數分析...................................22
4.4 醫療專業能力、醫病溝通對醫病信任造成之影響................22
4.5 醫病信任對再回診意願之影響..............................23
4.6 探討信任之中介效果.....................................24
4.7 醫院形象對再回診意願之影響..............................26
4.8 結構方程模式分析.......................................27
4.8.1 路徑圖轉換方程式.....................................27
4.8.2 研究假說............................................28
4.8.3 模式估計與適配度檢查..................................29
第五章 研究結論與建議
5.1 研究結論..............................................35
5.2 研究限制..............................................35
5.3 研究建議..............................................36
參考文獻
英文文獻..................................................38
中文文獻..................................................41
附錄
研究問卷..................................................44

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