臺灣博碩士論文加值系統

台灣牙醫自1998年7月試辦實施「總額預算」以取代「以量計酬」制度，促使面臨飽和市場之牙科診所，不得不推廣自費醫療產品及服務，如植牙、活動牙套、齒列(顎)矯正、假牙和牙齒美白等為牙科診所之主要收入來源，其收入達到牙醫之醫療總收入58％的高水準，因此本研究將深入探討「患者採用自費醫療產品之意願」。
本研究之目的為探討醫療服務品質之醫療結構、過程、結果及產品屬性之牙科診所品牌、醫師口碑、價格、牙科診所相對優勢、相容性等八項因素對採用自費醫療產品之意願的影響，進而提供牙科診所客觀的管理意涵與策略。而本研究以高雄地區之具有「齒列(顎)矯正」醫療權威的ABC牙醫聯盟和部份小型診所之受過齒列(顎)矯正口腔衛生教育的牙科病患為研究對象，有效回收問卷共430份，本研究採用SPSS17.0統計軟體，先以量表信度分析檢測本問卷之可信度，在以因素分析確認各構面之ㄧ致性，最後在以迴歸分析探討此八項構面對病患採用自費醫療產品意願間的影響。
依據實證研究結果發現，病患在醫療服務品質和產品屬性共八項因素的考量皆對齒列(顎)矯正採用意願有正面的影響關係，因此牙科診所除了要提升整體醫療品質之水準外，更應專注於診所品牌和醫生口碑的建立，以促使牙科診所擁有相對優勢，並提供自費醫療產品與生活相容性的相關資訊予有需求之患者，以提升病患採用該診所之自費醫療產品的意願。此外本研究發現，影響病患採用意願之程度依序為牙科診所相對優勢、醫療結構、醫生口碑、相容性、牙科診所品牌和醫療結果；而病患對醫療過程和價格並非如此重視，有可能是基於病患認為大部分的牙科療程較一般手術所需時間來的短，且醫療技術較不複雜；另外，價格會排除在外，有可能是基於雖然病患在意自費醫療產品之價格，但畢竟有關於個人之生命健康問題，所以在這麼多的衡量因素中，顯然對低價格的自費醫療產品之品質是有所存疑的；因此相對於其它變數來說，醫療過程與低價格變得較不易影響病患對自費醫療產品的採用意願。

Last July 1998, Taiwan’s dental clinics first tried implementing the “Global budget system” in replacement of the “Fee for service” system left dental clinics currently facing the saturated market with no choice but to introduce self-paid medical products and service such as dental implants, movable braces, orthodontic corrections, dentures and dental whitening. These self-paid products and services became the dental clinics’ main source of earnings which occupy around 58% of the total earnings, thus, this study will further explore “the adoption preference of self-paid medical products by patients.”
The purpose of this study is to explore the effect of the framework, process and outcome of the quality of health care service as well as the effect of product attributes such as brand, doctor’s word of mouth, price, dental clinics’ relative advantage and compatibility to the adoption intention of self-paid medical products and provide objective management implications and strategies to dental clinics. This study drew out samples from the patients of dental clinics certified by the ABC dental association to be specializing in “orthodontics” treatment and those clinics that received dental sanitary trainings in Kaoshiung. Total valid questionnaires were 430 copies, and this study made use of the SPSS statistical software to measure the reliability of the said questionnaires. Also, factor analysis was used to verify the consistency of the dimensions and finally, regression analysis was used to explore the effect of the eight dimensions mentioned in this study on the adoption intention of self-paid medical products.
Empirical test suggests that the quality of health care service and product attributes perceived by patients has a positive influence on the adoption intention of orthodontics treatment. Thus, aside from improving the quality of the overall medical treatment, clinics should focus more on the establishment of its brands and doctors’ word of mouth in order for the dental clinic to attain relative advantage and provide self-paid products and compatible and related information to patients as well as increase the adoption intention of self-paid medical products. Moreover, this study found that the factors influencing adoption intention comes in the following order: the relative advantage of the dental clinic, medical structure, doctors’ word of mouth, compatibility, dental clinics’ brands and treatment outcome; while patients doesn’t give much importance to the treatment process and price, this may be because the patients believe that most dental treatments consume little time compare to the common surgeries, and skills used for treatments aren’t complicated; Also, price is not considered, though patients might care about the price of the self-paid product, but since it involves one’s health and safety, most of the patients would tend to doubt the quality of lower priced products. Thus, in contrast to other variables, treatment process and low price doesn’t have much effect on the adoption intention of self-paid products by patients.

摘要 ..............................................I
Abstract ..............................................II
誌謝 ..............................................IV
圖目錄 ..............................................IX
第一章 緒論 .....................................1
第一節 研究背景 .....................................1
第二節 研究動機 .....................................3
第三節 研究目的 .....................................3
第四節 研究問題 .....................................4
第五節 研究方法 .....................................5
第六節 操作型定義 ...................................5
第七節 研究限制 .....................................6
第八節 研究重要性 ...................................6
第九節 研究流程 .....................................7
第二章 文獻探討 .....................................9
第一節 健保總額預算制度 ............................9
第二節 齒列(顎)矯正 ............................12
第三節 醫療服務品質 ............................13
第四節 產品屬性 .....................................35
第五節 採用意願 .....................................54
第三章 研究模型與假設................................59
第一節 研究架構 .....................................59
第二節 研究假設 .....................................60
第四章 研究設計 .....................................65
第一節 問卷設計 .....................................65
第二節 研究變項之操作型定義 .........................68
第五章 資料分析 .................................... 74
第一節 問卷回收狀況 .................................74
第二節 敘述統計分析 .................................74
第三節 信度與效度分析 ...............................91
第四節 個人基本資料及個人屬性與各構面之關係 ........99
第五節 Pearson相關分析 .............................110
第六節 假設檢定分析.................................111
第七節 假設驗證結果.................................124
第六章 結論與建議...................................125
第一節 結論.........................................125
第二節 管理意涵與建議...............................132
第三節 本研究研究限制...............................136
第四節 後續研究建議.................................137
參考文獻 .............................................139
附錄 .............................................152

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