臺灣博碩士論文加值系統

背景：
　　「信任」為維持醫病關係的重要元素之一，也是預測醫療服務成效的最佳指標，且當病患信任醫師時，治療過程的配合度會提高，因此可以得到較成功的醫療結果或病情控制，亦能夠減輕病患本身焦慮、減少更換醫師或醫院進而增加治療效果及降低所耗費的醫療資源；而台灣不同族群民眾對於我國醫療保健系統信任程度如何，近年來較少有類似文章發表，激發研究者探討此議題之動機。
資料與方法：
　　研究以行政院國家科學委員會人文及社會科學發展處，其進行之台灣社會變遷基本調查計畫第六期第二次調查計畫執行之報告作為次級資料庫，剔除未達標準之樣本後(N=1978)，以描述性統計與推論性統計做資料分析。
結果：
　　影響民眾對醫師信任的變項為年齡、宗教信仰、健康狀況、自覺生活是否快樂等；影響民眾對醫療保健系統之信任的變項為每月收入、宗教信仰、社會階層自我認知、自覺生活品質滿意與自覺生活是否快樂等。
結論與建議：
　　民眾的宗教信仰和自覺生活是否快樂均與醫師信任及醫療保健系統信任有相關，因此建議未來研究方向可朝此方向進行更多探討。而影響民眾對醫師信任、醫療保健體系信任的詳細因素，是否為因醫師行為、醫師展現出的態度、醫療院所等級等因素有關，需後續更深入的探討。

Background：
Trust is one of the important relationships between physician and patient. It can be the indicator of predicting effectiveness of health care delivery. Moreover, patients will get more positive treatment outcomes or disease control, and their anxiety will alleviate when they trust their physicians. In addition, patients will receive more positive treatment results, owing to the lower rate of visiting different physicians or hospitals, thus conserving more medical resources. This study aims to explore the demographic, socioeconomic, health and life indicators associated with trusts in physicians and health care system in Taiwan.
Method：
This study used data from the Taiwan Social Change Survey (TSCS) Phase6, Wave2 to conduct analyses. TSCS is released by the National Science Council. After excluding missing data, a total of 1,978 subjects were included in this study. Both descriptive and inferential statistics were used to describe the factors associated with trusts in physicians and health care system.
Result：
Factors associated with trust in physicians are: age, religion, health status, perceived happiness; the factors associated with trust in health care system are: monthly income, religion, perceived social level, perceived quality of life, and perceived happiness.
Conclusion：
Religion and perceived happiness are factors associated with both trusts in physicians and health care system. Policy makers need to pay more attention to these factors to improve the relationship between patients with physicians and health care system. Other possible factors not included in this study, such as behaviors, attitudes of physicians, and scale of health care facilities, need further study to analyze whether they are associated with trusts in physicians and health care system.

目 錄
第一章　緒論1
　　第一節　研究背景與動機1
　　第二節　研究目的2
第二章 文獻探討3
　　第一節　信任3
　　第二節　病患對醫師的信任16
　　第三節　病患對醫療保健系統的信任20
第三章 研究方法22
　　第一節 研究架構22
　　第二節 資料來源與研究對象25
　　第三節 研究變項及操作型定義26
　　第四節　資料處理與分析方法43
第四章　研究結果44
　　第一節　社會人口學特質、健康狀態、生活滿意度、醫療信任分佈44
第二節 民眾對於醫師信任、醫療保健系統信任相關分析46
第三節 醫師信任、醫療保健系統信任之相關風險分析49
第五章 討論53
第一節 探討影響民眾對於醫師信任的相關因素54
第二節 探討影響民眾對於醫療保健系統的相關因素57
第六章 結論與建議60
第一節 研究結論60
第二節 建議61
第三節 研究限制62
參考文獻63
中文文獻63
英文文獻66

表 目 錄
表2-1　不同學者對信任所做的定義與解釋5
表2-2　不同領域內對信任的定義13
表3-3　研究架構之問卷變項操作型定義29
表4-1-1　受訪者社會人口學變項之分佈情形73
表4-1-2　受訪者健康狀態之分布情形75
表4-1-3　受訪者生活滿意之分佈情形76
表4-1-4　受訪者醫師信任、醫療保健系統信任之分佈情形77
表4-2-1 醫師信任與各控制變項相關分析78
表4-2-2 醫療保健系統與各控制變項相關分析80
表4-3-1 醫師信任與人口學變項、生活型態及健康狀態變項之邏輯斯迴歸分析(Crude)82
表4-3-2 醫師信任與人口學變項、生活型態及健康狀態變項之邏輯斯迴歸分析(Adjusted)84
表4-3-3 醫療保健系統信任與人口學變項、生活型態及健康狀態變項之邏輯斯迴歸分析(Crude)86
表4-3-4 醫療保健系統信任與人口學變項、生活型態及健康狀態變項之邏輯斯迴歸分析(Adjusted)88
 
圖 目 錄
圖3-1 研究架構圖23

中文文獻
中央研究院（2009）。醫療保健政策建議書。中央研究院報告。
文蓓華（2012）。全民健康保險總額支付制度對醫院及醫師之影響-以某醫學中心為例。國立成功大學高階管理碩士在職專班(EMBA) 碩士論文。
何怡婷（2008）。探討乳癌病患對醫師信任與照護評價間關係。國立台灣大學公共衛生學院醫療機構管理研究所碩士論文。
吳明姿（2011）。癌症病人對臨床試驗之認知、態度與決策行為意向之探討。國立臺灣大學護理學研究所碩士論文。
呂慧琳（2010）。服務品質、醫病關係、信任與病患滿意度關係之研究-以署立金門醫院為例。國立高雄大學高階經營管理碩士在職專班碩士論文。
洪小涵、邱玉蟬（2011）。民眾溝通特質與策略對醫師滿意與信任的影響。臺灣公共衛生雜誌，30(6)，582-593。
洪曜、王沂釗、周兆平（2014）。增進憂鬱症患遵從醫囑因素之研究。中華心理衛生學刊，27(2)，201-221。
高禎璟（2012）。信任關係、工作滿足、之事分享與組織創新關係之研究-以空軍為例。南華大學企業管理系管理科學碩士論文。
張文華（2000）。組織信任之初探。人力發展月刊，80，14-27。
張苙雲、譚康榮（2005）。制度信任的趨勢與結構：多重等級評量的分析策略。台灣社會學刊，35，75-126。
張麗君（2007）。醫師情緒智能、病人信任與醫病關係相關性研究。義守大學管理研究所碩士論文。
許嘉猷（1986）。社會階層化與社會流動。台北：三民。
莊宛宜（2006）。住院病人信任與對醫師照護評價關係之探討。國立台灣大學醫療機構管理研究所碩士論文。
陳秀敏、李尹暘、林麗娟（2013）。糖尿病患血糖控制的假期效應－醫病關係之影響。醫務管理期刊，14(1)，1-17。
林美伶、葉莉莉、陳清惠（2009）。影響病人參與醫療決策之論述。護理雜誌，56（3），83－87。
陳慧如、吳綺蓁（2010）。信任之概念分析 (Concept Analysis of Trust) 。長庚護理，21(2)，158-164。
馮立誠（2005）。信任的定義與理論定位之命題研究。朝陽科技大學企業管理系碩士論文。
梁若瑜 譯（2002）。從信任開始：成功領導的基本條件 (Building trust)，Solomon, R. and Flores, F，麥田出版。
楊中芳、彭泗清（2001）。人際信任的構念化：一個人際關係的觀點。遠流出版，371-399。
葉永文（2012）。醫病關係：一種信任問題的考察。台灣醫學人文學刊，13(1、2)，77-103。
盧安邦（2009）。醫病互動的行動邏輯。慈濟大學傳播學研究所碩士論文。
戴志宇、劉俞志（2012）。醫生行為對病患信任的影響。第一屆服務與科技管理研討會。
蘇武龍（2000）。住院服務品質與病患滿意度之探討-以成大、奇美醫院為例。國立成功大學工業管理學系碩士論文。
 
英文文獻
Anderson, L., & Dedrick, R. (1990). Development of the Trust in Physician scale: a measure to assess terpersonal trust in patient-physician relationships. Psychological reports, 67(63 Pt 62), 1091.
Andaleeb, S.S., (1992). The Trust Concept: Research Issues for Channels of Distribution, Research in Marketing, 11, 1-34Anthony Giddens. (2000). The Third Way and its Critics. Publisher Polity Press, 56.
Aulakh, P. S., Kotabe, M. & Sahay, A. (1996). Trust and performance in cross-border marketing partnerships: A behavioral approach. Journal of International Business Studies,, 27(5), 1005-1032.
Beard, E. L. J. (2004). Consumer Trust in Healthcare Organizations Is Waning: How will 21 Century Leaders Bridge the Gap?
Berry, L. L. (2000). Cultivating Service Brand Equity. Journal of the Academy of Marketing Science, 28(1), 128-137.
Bonds, D. E., Camacho, F., Bell, R.A., Duren-Winfield, V.T., Goff, D.C.(2004). The association of patient trust and self-care among patients with diabetes mellitus. BMC Family Practice.
Boon, S. D., & Holmes, J. G. (1985). The dynamics of interpersonal trust:Resolving uncertainty in the face of risk. New York: Cambridge University., 190-211.
Bova , C., Fennie ,K.P., Watrous E.,Dieckhaus ,K.,Williams ,A.B. (2006). The health care relationship (HCR) trust scale: development and psychometric evaluation. Research In Nursing & Health Oct 29.
Bradach, Jeffery L. and Eccles, Robert G., (1989). Price, Authority, and Trust: From Ideal Types to Plural Forms, Annual Review of Sociology. 15, 97-118.
Brockner, J., & Siegel. P.A. (1996). Understanding the interaction between procedural and distributive justice: The role of trust. Trust in Organizations:Frontiers of theory and research. 390-413.
Carnevale, D. G., & Wechsler, B. (1992). Trust in the public sector: individual and organizational determinants. Administration & Society, 23(4), 471-494.
Caterinicchio, R. P. (1979). Testing plausible path models of interpersonal trust in patient-physician treatment relationships. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 13,81- 99.
Connell N.A.D., M., R. (2006). Conceptualisations of trust in the organizational literature: Some indicators from a complementary persprctive. Journal of Health Organization and Management, P 417-433.
Creed,W.E.D., & Miles, R. E. (1996). Trust in organizations: A conceptual framework linkingorganizational forms, managerial philosophies, and the opportunity costs of controls. Trust in organizations: Frontiers of theory and research. 16-38.
David Mechanic, S. M. (2000). Concepts of trust among patients with serious illness. Social Science & Medicine.
Deutsch, M. (1958). Trust and suspicion. Journal of conflict Resolution, 2, 265-279.
Deutsch, M. (1973). The resolution of conflict: Constructive and destructive processes. New Haven: Yale University Press.
Doney, P. M. a. J. P. C. (1997). An Examination of the Nature of Trust in Buyer-seller Relationships. Journal of Marketing., Vol.61, 35-51.
Driks, K. T. F., D. L. (2001). The Role of Trust in Organizational Settings. Organization Science, 12, 450-467.
Fiscella K, M. S., Franks P. (2004). patient trust: is it related to patient-centered behavior of primary care phtsicians? Med Care,2004.
Gambetta, Diego, (1988). Can We Trust Trust? in Trust - Making and Breaking Cooperative Relations, Blackwell, New York.
Goold, S. D., & Klipp, G. (2002). Managed care members talk about trust. Social Science & Medicine,, 54(6), 879-888.
Hall, M. A., Dugan, E., Zheng, B., & Mishra, A. K. (2001). Trust in physicians and medical institutions: what is it, can it be measured,and does it matter? Milbank Quarterly, 79(4), 613-639.
Hall, M. A. (2006). Researching medical trust in the United States. Journal of health organization and management 20(5), 456-467.
Holly Fernandez Lynch. (2008). Conflicts of Conscience in Health Care : An Institutional Compromise. Basic Bioethics 296-299
Hosmer, L. T. (1995). Trust: The connecting link between organizational theory and philosophical ethics. Academy of Management Review, 20(2), 379-403.
Humphrey, J., & Schmitz, H. (2002). How Does Insertion in Global Value Chains Affect Upgrading in Industrial Clusters? Regional Studies, 36(9), 1017.
Jarvenpaa, S. L., K. Knoll, D. Leidner. (1998). Is anybody out there?: The antecedents of trust in global virtual teams. J. Management Inform. Systems 14(4) 29–64.
Kao, A. C., Green, D. C., Davis, N. A., Koplan, J. P., & Cleary, P. D. (1998). Patients’ trust in their physicians. Journal of General Internal
Medicine, 13(10), 681-686.
Keating NL, G. D., Kao AC, Gazmararian JA, Wu VY, Cleary PD.(2002). How are patients' specific ambulatory care experience related to trust, satisfaction, and comsidering changing physicians? J Gen Intern Med.
Krackhard, D. B., D. (1994). Intraorganizational networks- the micro side. Advances in social network analysis: Research in the social and behavioral sciences,, 207-229.
Krupat, E., Bell RA., Kravitz RL., Thom D., Azari R. (2001). When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 1057-1062.
Lewis, J. D. W., A. (1985). Trust as a social reality. Social Forces, 63(4),967-985.
Luhmann, N. (1979). Trust and Power. Chichester: John Wiley & Sons.
Mainous, A,G, Hueston, W,J Everet,t C,J, Diaz, V,A (2006). Nasal carriage of Staphylococcus aureus and methicillin-resistant S. aureus in the United States, 4 132-137.
Mayer, R. C., Davis, J. H., and Schoorman, F. D.,. (1995). An Integrative Model of Organizational Trust. Academy of Management Review, 20(3), 709-734.
McAllister, D. J. (1995). Affect and cognition-based trust as foundations for interpersonal cooperation in organizations. Academy of Management Journal, 38(1), 24-59.
Mechanic, D. (1998). The functions and limitations of trust in the provision of medical care. Journal of Health Politics, Policy and Law, 23(4), p.261-271.
Mechanic, D., & Meyer, S. (2000). Concepts of trust among patients with serious illness. Social Science & Medicine., 51(5), 657-668.
Mishra, J. M., M. A. (1990). Trust in employee/employer relationships: A survey of West Michigan managers. Public Personnel Management, 19(4), 443-486.
Misztal, Barbara A. (1996) Trust in Modern Societies: The Search for the Bases of Social Order Polity Press.
Moore, S. F., Shaffer, L. S., Pollak, E. L., & Taylor-Lemcke, P. (1987). The effect of interpersonal trust and prior common problem experience on common management. Jurnal of Social Psychology, 127(19-29).
Morgan, R. M. a. H., S.D. (1994). The Commitment-Trust Theory of Relationship Marketing. Journal of Marketing., 58, 20-38.
Porter, L. W., Lawler, E. E., & Zanna, M. D. (1975). Behavior in Organizations. New York: McGraw-Hill.
Rempel, J. K., Holmes, J. G., & Zanna, M. D. (1985). Trust in close relationships. Journal of Personality and Social Psychology, 49(1), 95-112.
Robbins, R. (1988). Betrayed! How You Can Restore Sexual Trust and Rebuild Your Life. Adams Media Corporation.
Rotter, J. B. (1967). A new scale for the measurement of interpersonal trust. Journal of Personality, 35, 651– 665.
Rousseau, D. M., Sitkin, S. B., Burt, R. S., and Camerer, C.,. (1998). Not So Different After All: A Cross-Discipline View of Trust. Academy of Management Review, 23, 393-404.
Sabatelli, R. M., Buck, R., & Dreyer, A. (1983). Locus of control, interpersonal trust, and nonverbal communication accuracy. Journal of Personality and Social Psychology, 399-409.
Sabel, C. F. (1993). Studies Trust: Building New Forms of Cooperation in a Volatile Economy. Human Relations 46, no.9, 1132–1172。
Sellman and Philos. (2007). Trusting patients, trusting nurses. Nursing Philosophy. Volume 8, Issue 1, pages 28–36.
Schurr, P. H., & Ozanne, J. L. (1985). Influences on exchange processes: Buyers' preconceptions of a seller's trustworthiness and bargaining
toughness. Journal of Consumer research, 939-953.
Sitkin, S. B. S., D. (1996). The road to hell: The dynamics of distrust in an era of quality., In Kramer, R. M. & Tyler, T. R. (Eds.). Trust in organizations: Frontiers of theory and research, CA: Sage, Thousand Oaks, 196-215.
Spekman, R. E. (1988). Strategic supplier selection: understanding long-term buyer relationships. Business Horizons, 31(4), 75-81.
Thom, D. H. (2000). training Physicians to Increase Patient Trust. Journal of Evaluation in Critical Practice.
Thom, D. H., Hall M.A., Pawlson L.G. (2004). Measuring patients’ trust in physicians when assessing quality of care. Health Affair, 23(4), 124-132.
Trachtenberg, F., Dugan, E., & Hall, M. A. (2005). How patients trust relates to their involvement in medical care. J Fam Pract, 54(4), 344-352.
Tschannen-Morgan, M., & Hoy, W. (1997). trust in schools. A171.
Whitener, E. M., Brodt, S. E., Korsgaard, M. A., & Werner, J. M. (1998). Mangers as initiators of trust: An exchange relationship framework forunderstanding managerial trustworthy behavior. Academy of Management Review, 23(3), 513-530.