服務品質測量模式應用於自費健康檢查之適用性與滿意度關聯性之探討--以北市某醫學中心為例

Abstract

在服務業，提倡以顧客為中心的服務精神；在醫院，正在開始推廣以病人為中心的概念。自費的醫療服務項目中，又以健康檢查者是少數持有非負面情緒的到院者之ㄧ。但自費醫療市場，仍然存在醫病資訊的不對稱以及消費者缺乏搜尋最低價格的誘因。在提倡品質提升之下，一般的品質指標又未能被大眾所判讀，對於到院者而言，服務品質和高科技儀器是其重視的部份，而服務品質則對於提升顧客滿意度有顯著的解釋力。因此本研究將一般服務業的服務品質量表，應用於較貼近一般市場的自費健康檢查醫療服務上，並探討對滿意度的影響情形。 在測量工具使用上，除了考量文化及翻譯上的修改之外，也使用不同的方法學，以檢驗理論架構之整體效度。考量使用探索性因素分析(EFA)方法的前提，以及資料本身的限制之下，首先使用斜交轉軸法，以及主成分萃取法和最大概似萃取法，針對不同測量變項來萃取因素。之後，以原始理論架構為前提，再以驗證性因素分析方法(CFA)，增加對潛在變項相關性的估計，和針對非相對應的各測量變項與潛在變項之間的關係，進行參數估計。依此五種因素分析的結果，於控制人口學變項之下，探討對滿意度之關連性。本研究為橫斷性研究，因為研究樣本屬特殊對象，必須取得醫院及受檢者高度的配合。礙於實際考量下，僅選取台北市一家醫學中心來進行研究，回收問卷有效217份，回收率約55％。 EFA分析之前，量表在信度檢驗上Cronbach's Alpha達到0.9以上，在適用性檢定KMO值達0.9以上。主成分分析都較最大概似法所得的分析結果之因素負荷量高。再利用CFA方法，對潛在變項相關性以及多維關係做逐步的修正。修正後增加了13個維度的關係，而模式配適度指標為χ2(186)＝381.468，RMSEA=0.06，CFI=0.916，模式在增加多維關係後的配適度較佳。在迴歸分析結果上，EFA所得之因素都將「保證」以及「體貼」兩構面合併。且並非每一個服務品質的因素，對於滿意度都有顯著的影響。而服務品質對於醫事人員服務態度的解釋力，高於對健康檢查中心所提供的附加服務（如：餐點、休息室規劃等）。顯示在醫事服務人員的態度上改善上，對於服務品質以及滿意度的提升，會有顯著的貢獻。尤其在體貼以及保證兩個構面上在任何模式下都呈現顯著的正向影響。考慮到｢期望｣的｢服務品質｣是長期態度的累積，而「滿意度」是單次的評估。在因果關係的評斷上，還需要長期性的研究以繼續探討。

The concept of customer-center is popular in service industry, while patient-centered care is emerging in health care as well as hospital. In the self-pay medical service items, health examiners are one of those who come to the hospital holding non-negative mood. It is quite common in self-pay services that consumers have the information asymmetry and are lack the incentives of searching the lowest price. Even though there are some available information, the general qualities indicators are hard to be understood by the public. High-Tech facilities and serve quality are important to service users. Service quality has significant relationship with customers’ satisfaction. The purpose of this study is to apply SERVQUAL instrument to self-pay health examination service of health care for examining the appropriateness and explore its relationship with satisfaction of services. The survey tool, SERVQUAL, is modified by both culture and dual-translation. In addition, the researcher applied different methods to probe the quality gap in theory structure. At first, this study considered principal components, the maximum likelihood extraction methods and the promax oblimin rotation method in the exploratory factor analysis (EFA) owing to its constraint and data limitation. Later on, it was regarded the original theory structure PZB, 1988 as the prerequisite and considered using the confirmatory factor analysis (CFA) to increase the estimation among latent variables, as well as the estimation among all the measurement variables and latent variables. According to the five results of factor analysis as independent variables, the analysis plan included controlling for the demography and exploring the relationship between service quality and satisfaction. This research is a Cross-sectional study. There are 217 effective samples with the response rate 55%. Before EFA, the instrument had good reliability of internal consistency with Cronbach's Alpha higher than 0.9, and good fitness of KMO value higher then 0.9. Results from principal components had higher factor loading than from the maximum likelihood extraction methods. In CFA, the research obtained 13 additional degrees between measurement variables and latent variables. The goodness of fit indexes that included χ 2 (186)=381.468, RMSEA =0.06, CFI =0.916 were better after multi-level of measurement with latent variables. Two separate dimensions of “assurance” and “empathy” in the original theory PZB, 1988 are combined into one factor in EFA. Some of the dimensions in service quality had no significant relationship with satisfaction. The research also found that there was higher adjusted-R2 between service quality and the satisfaction of medical workers than in service quality and the satisfaction of hospital’s additional service items. Empathy and assurance was the most important factor with satisfaction. It is essential to have longitudinal study to support the causal relationship.