醫院導入診間電子支付之內部接受程度與影響因素 —以新北市某醫院為例

Abstract

醫療服務型態逐漸從以醫療體制為中心轉型為以病人為中心，著重醫療服務品質、病人安全、效率、顧客體驗及滿意度。為了提供病患更有效率的批價模式、更完善的醫療服務且創造更好、更新的顧客體驗，各醫院陸續導入多元批價設備及系統，提供更方便、更安全也更有效率的批價服務。 個案醫院於 2008年 7月，率全國之先施行「診間悠遊卡批價服務」。此一e化批價流程之導入，預期效益除可以縮短批價時間、增加批價效率、提升醫療服務品質、提升滿意度、精簡時間成本外，又可以促進產業跨界合作，達民眾、醫院及悠遊卡公司三贏格局。然而，個案醫院統計自2014年1月至2016年7月門診悠遊卡結帳比例平均僅為8.2%，民眾選擇診間悠遊卡結帳比例偏低，大部份病患仍習慣透過傳統的方式結帳。探究可能原因，除民眾消費習慣等外部因素以外，醫院內部接受程度也直接影響診間悠遊卡支付成效。因此，本研究主要目的在探討醫院導入診間電子支付之內部接受程度及影響因素。 本論文主要在研究醫院內部人員對診間電子支付之接受程度，研究重點在探討各個構面對於使用意願的影響情形，研究以延伸性科技模式為理論架構，接著以問卷調查法對醫院內部人員展開調查，問卷預試經探索性因素分析後，參考整合性科技模式重新命名及調整部分構面名稱及假設，最後再以AMOS驗證本研究假設並計算各因素之影響能力。 本研究結果顯示醫院內部人員對於各因素的同意程度感受頗為平均且醫院內部人員對醫院診間電子支付之整體同意程度與各構面同意程度達到中上程度之同意程度，顯示院內人員對醫院推行診間電子支付政策的認同與支持。本研究另分析不同人口統計變項之醫院內部人員，包括年齡、性別、公職與否、是否具管理職位、職務、主要工作地點、教育程度、總年資、在本院年資及居住地，對診間電子支付之同意程度的差異，最後以AMOS分析驗證假說，結果發現「認知有用性」及「社會影響」等兩個構面，對於診間電子支付「使用意願」有顯著正向的影響力；「系統複雜性」則負向影響「認知易用性」與「使用意願」，但不具顯著意義；「認知易用性」及「績效期望」會正向影響「認知有用性」，而「促成因素」會正向影響「認知易用性」，此結果與過往文獻所呈現的結果具有一致性。然而，本研究結果中，「認知易用性」與「使用意願」及「結果展現性」與「認知有用性」呈顯著負相關，不同於大部分延伸性科技接受模式之研究結果。 本研究提出之研究模型足以提供後續醫療機構對醫療電子支付內部接受程度相關研究之參考基礎。另外，在醫院內部管理層面，本研究的研究結果可讓醫院管理者了解醫院內部對電子支付之接受程度及主要影響使用意願之因素，可做為未來系統需求、介面及功能設計或改善之參考。

The focus of medical services has gradually shifted from a health care system to a patient-centered approach, focusing on the quality of medical services, patient safety, efficiency, and customer experience and satisfaction. In order to provide patients with more efficient pricing models, better medical services and to create a better and more updated customer experience, hospitals have introduced multi-dimensional cashiering equipment and systems to provide more convenient, safer and more efficient pricing services. In August 2008, the case hospital is the first one in Taiwan to implement the 'clinical easy card electronic payment”. The introduction of the e-payment process not only can shorten the time of pricing, increase the efficiency of pricing, improve the quality of medical services, improve satisfaction, streamlining time costs, but also can promote cross-border industry cooperation that lead to the win-win situation among patients, hospitals and the associated industry. However, the average percentage of using easy card to pay in clinic in the case hospital was only 8.2% between January 2014 and July 2016. The proportion of patients choosing clinical e-payment was low, and most of the patients were still accustomed to using the traditional way to check-out. To pinpoint the possible causes, except the public consumption habits and other external factors, the hospital acceptance of using clinical e-payment effects the outcome of this payment method. The purpose of this study is to explore the internal acceptance and influencing factors of e-payment in the hospital. This study mainly focused on the acceptance of electronic payment among hospital staff, and the focus was to determine the influence of each factor on the use intension of electronic payment. In this study, the theoretical framework was based on the extended technology acceptance model, followed by a questionnaire survey to carry out an investigation among internal staff. The pre-test of the questionnaire included exploratory factor analysis, renaming of factors based on the structure and definition of Unified Theory of Acceptance and Use of Technology (UTAUT) and adjusting the hypothesis. Finally, AMOS was used to validate the hypothesis and calculate the impact of each factor. The results of this study showed that hospital staffs agree fairly about each factor, and the degree of consent of the hospital staff to the electronic payment has reached the middle to upper level of agreement, indicating the support of clinical staff toward the policy of electronic payment implemented by the hospital. In this study, the variance analysis and t-test were used to analyze the demographic variables of the hospital, and the acceptance level on electronic payments among hospital staff was analyzed based on different criteria, including age, sex, serving as a public officer or not, having a management position, hospital duties, working location, educational level, working experience in total and in the hospital, and place of residence. Finally, AMOS was used to analyze the hypothesis, and the results showed that 'perceived usefulness' and 'social influence' had significant positive correlation with the 'intention to use' of electronic payment in clinic, while 'system complexity' had a negative impact on 'perceived ease of use' and ' intention to use ', but it does not reach statistical significance. ' perceived ease of use ' and 'performance expectancy' were positively correlated with ' perceived usefulness ', while as 'facilitating conditions' was positively correlated with ' perceived ease of use '. These results are consistent with the results of previous studies. However, our results of significant negative correlations between ' perceived ease of use 'and “intention to use” and “result demonstrability” and ' perceived usefulness 'contradict to the results of most extended technology acceptance models. In summary, the research model proposed in this study is sufficient to provide a reference basis for the related research on the internal acceptance of medical electronic payment. In addition, this study has a significant contribution on the internal management level as the results of this study allowing hospital managers to understand the hospital's internal acceptance of electronic payments and the main factors that affect the use of willingness of this service. Ultimately, this study could be a reference for future improvement of hospital system requirements and interface and functional design for hospital managers.