中醫院所病人自費醫療行為之研究

Abstract

近年來中醫院所家數逐年增加，中醫醫療服務市場越趨競爭，中醫院所遂積極向自費醫療服務市場發展，以期達到良好的經營績效。本研究以位於雲林縣西螺鎮的延平慈愛中醫診所、慈愛綜合醫院中醫部及位於台中市的行政院衛生署台中醫院中醫科之門診病患為研究對象，研究目的如下：1.瞭解中醫院所病人自費醫療之就醫背景、經驗、要因及期望費用。2.找出中醫院所病人自費醫療之原因、期待、可接受醫療項目與費用及其就醫背景等之相互關係。3.找出各項因素對中醫健保不給付項目的自費意願及就診中醫時可接受的自費比例之影響程度。4.期望研究結果兼具學術研究及實際應用價值，可提供中醫院所有效經營自費醫療服務、提升醫療服務品質及自費醫療服務未來發展之參考與應用。 本研究總計回收問卷1,000份，除敘述性統計外，也進行受訪者就醫背景與自費醫療行為中之雙變項交叉分析，並以邏輯斯迴歸分析各項因素與健保中醫不給付項目之自費意願及中醫看診可接受的自費比例等二個變項的影響。 研究結果發現，民眾最常去中醫診所看中醫，綜合醫院的中醫部次之。有50.8%的受訪者知曉中醫健保醫療資訊，47.6%的民眾到健保中醫院所看診時，若遇上中醫健保不給付的項目，有意願主動要求自費，對中醫健保服務大致滿意。民眾自費看診的主要原因以醫生推薦、親友推薦、醫生要求及新的醫療方法為主。訊息來源以親友介紹及醫院看板最多。自費看診的期待以用藥會比較好及醫生會看得較仔細為主。想自費的範圍以保健養生（含身體調理）、濃縮中藥、中醫健檢（含經絡檢查等）、推拿、中醫美容、產後護理（坐月子）服務、丸劑、飲片及敷藥為主。可接受的自費比例，66.1%的受訪者傾向少數自費、多數健保，25.5%的受訪者希望一半自費、一半健保。自費看診困難（擔心）之處，主要是無法判斷與價格相對應的醫療品質、買到假藥及經濟負擔太重等。 綜合上述分析，研擬中醫院所自費醫療服務經營之參考策略如下：1.提升醫師醫療技術水準，增加民眾對中醫師與中醫院所的忠誠度。2.加強民眾對中醫藥的知識與信心。3.藉由雜誌、期刊及網際網路等廣告及醒目的醫院看板，加強醫療行銷。4.多宣導中醫健保醫療資訊，提升病患對中醫健保服務的滿意度。5.自費醫療服務項目可多利用雜誌與期刊進行報導及網友推薦，醫生亦可主動推薦。6.建議多增加內科及婦科相關的自費醫療項目，如飲片、包紮及保健養生（含身體調理）等。7.對中醫診治有較高自費意願的族群，可以採用提醒及黏著行銷手法，讓其成為經常消費的一群。8.對中醫診治自費意願較低的族群，可以採用置入及試用促銷等行銷手法，讓其漸漸提升自費醫療服務利用率。

Self-paying Chinese Medical services are thought to develop actively in recent years due to the market is more and more competitive. This study issued questionnaires to the patients of YanPing-TzuAi Chinese Medical Clinic (Siluo Township, Yunlin County), Department of Chinese Medicine in Tzu-Ai General Hospital (Siluo Township, Yunlin County), and Department of Chinese Medicine in Taichung Hospital (subordinating to the Health Department of Executive Yuan in Taichung City). The intentions of the study are: 1. To know the background, experience, factors and expected expenditure of patients' self-paying Chinese Medical services. 2. To find the correlations between the patients' background and the cause, expectation, acceptable treatments and expenditure of self-paying Chinese Medical services. 3. To find the effect of the factors regard the patients' wish and the acceptable proportion of self-paying Chinese Medical services. 4. May the result of the study could be helpful to operate self-paying Chinese Medical services and increase the performance and quality. There were 1,000 received and useful questionnaires. Besides the Descriptive Statistics, Chi-Square Test and Correlation were used to analyze the relationship between any two factors in the patients' background and self-paying behavior. Furthermore, Logistic Regression were employed to analyze the effect of the factors regard the patients' wish and the acceptable proportion of self-paying Chinese Medical services. The study results showed that clinic is the first choice of Chinese Medical services, and department of Chinese Medicine in General Hospital is the second one. There were 50.8% patients know the information of National Health Insurance (NHI) of Chinese Medicine, and the services were satisfied most of them. The patients' wish of voluntary self-paying is 47.6%, and the major reasons of that are physicians' recommendation, relatives' and friends' recommendation, physicians' request and some new medical services. Relatives' and friends' introduction and hospital's signboard is the major source of the information. Better medicining and more carefully diagnosing is the major expectation of self-paying Chinese Medical services. The major services of self-paying include keeping in good health, concentrated Chinese Medicine, health examination, naprapathy, cosmetology, providing postpartum service and help, medical pills, decoction of medicinal ingredients and putting on medication. In regard to the acceptable proportion of self-paying Chinese Medical services, 66.1% patients wish to have more NHI and 25.5% could accept half of self-paying. The majot anxieties about self-paying medical services include difficult judgment between health quality and the expenditure, pseudo-medicine and too expensive services. According to the study results, some practical applications and strategies to operate self-paying Chinese Medical services are: 1. To increase medical techniques in order to promote patients' loyalty. 2. To enhance patients' knowledge and confidence of Chinese Medicine. 3. To enhance the marketing by magazines, internet and signboard. 4. More advertisement about the information of NHI in order to promote patients' satisfaction of the services. 5. Self-paying medical services could be more recommendation by magazines, internet and physicians. 6. To increase self-paying medical services of internal medicine and gynecology such as decoction of medicinal ingredients, putting on dressing and keeping in good health are proposed. 7. In regard to the patients who with more wish for self-paying, branding marketing and maintaining customer relationships are suggested promoting the use of the services. 8. In regard to the patients who with less wish for self-paying, placement and experience marketing are suggested promoting the use of self-paying medical services.