病人採用高階醫療器材為醫療決策之因素探討

Abstract

高階醫療器材成本高昂，若因民眾或病人錯誤的知覺價值，導致非必要的需求，造成過多資源的投入，將使得社會資源無效率配置。本研究透過醫療必要性及醫療涉入兩個構面及其構面之若干主要組成因素，以問卷調查的方式探討病人依其形成的知覺價值，與採用高階醫療器材為手術醫療決策的關聯。 本研究於13所教學醫院規模以上醫院(北區6家、中區4家、南區3家)，不分科別共發出500份問卷，取得466份有效問卷。問卷分析顯示「醫療必要性」與病人採用高階醫療器材為手術決策間並無正面影響關係。這部分與文獻的結論相符。 另外就涉入途徑產生的知覺價值對採用高階醫療器材為醫療決策而言，研究結果顯示整體知覺價值對採用有顯著影響，但知覺價值的四個次構面中，價格價值為醫療決策中影響程度最低者，功能價值亦非影響程度最高者，此結果與其他知覺價值的研究，呈現不同的結果。至於在涉入途徑中的各項因素，以醫病關係為病人採用高階醫療器材為醫療決策的最重要因素；在資訊來源、資訊依賴及親友經驗上，雖對知覺價值以至於決策仍呈現正面顯著影響，本研究資料卻顯示出個別病人的特質差異，對應的醫療決策差距十分鮮明。此外，本研究亦發現，因同病症於第二次以上始採高階醫療器材為醫療決策之病人，在涉入途徑的各項因素形成知覺價值的程度發生改變。研究中還有的特殊觀察是涉入來源為高涉入時，其涉入對於決策有正增強效果，低度涉入來源及非有效涉入來源於決策時有負增強(削弱)效果。

It is costly for patients to adopt advance medical devices as means of medical treatments. The social resources will not be efficiently allocated if advanced medical devices are over invested due to the unnecessary demand stimulated by incorrect perceived values of paients.This study explores the relationship between the formations of patients’ perceived values and their decisions of adopting advanced medical devices throughquestionnaire survey from the perspectives of the two main dimensions, medical necessity and medical involvement, and their sub-dimensions. The survey is conducted in 13 teaching (or above) hospitals (six are in northern Taiwan, four in central Taiwan, and three in southern Taiwan). Four hundred and sixty-six questionnaires are valid among five hundred questionnaires collected from thirty-seven different clinics. According to the survey, no positive relationship between 'medical necessity and patients' decisions of adopting advanced medical devices' The result is consistent with that of Friedrick (2004). This study finds that overall the patients’ perceived value affects their adopting decisions of advanced medical devices. However, in the four sub-dimentions, different from other studies on perceived values, the price value has the least effect on the adopting decisions and the function value does not has decisive influence as expected.Among the affecting factors of involvement in medical care, doctor-patient interaction is the most dominant factor affecting patients’ decisions of adopting advanced medical devices. Information sources, information reliance, and family's and friends' experience also play a critical role for the adopting decisions. However, the survey shows that the patients' individual attributes have significant effects on their medical decisions. In addition, this study finds that for the patients having used advance medical devices for the same desease before, the degree of the effects of involvement factors on perceived valueis differeent. Another finding is that when in high involvement situations, the involvement enhances the adopting decisions while when in low involvement situations, the involvement weakens the decision.