摘 要

消費者消費行為的轉變在醫療業則轉變為病患導向行銷，早在1983年NCR顧客研究國際機構運用顧客決定醫療服務模式，每年針對1500名美國顧客透過電話問卷了解顧客對醫療服務行銷及對醫生的感受度。1999年NCR指出從新客戶身上賺錢所花費的成本為既有客戶的10倍。1999年由Taylor and Cosenza提出醫院看診選擇模式( HSMCM )，該模式描述環境所帶來的競爭危機導致醫療診所紛紛結束營業造成非自願性轉診，浪費醫療資源。而衛生署自2001年度開始試辦的社區醫療群運作模式(管理式醫療)以推動轉診制度，在不必重複檢驗浪費醫療資源情況下，鼓勵民眾就近就醫。因此本研究深入進行探討影響就醫者醫療選擇行為的再診意願關鍵因素，滿足並解決就醫者的需求及問題，如此方能提高舊病患對當地診所的信賴度，就近就醫。
本研究利用1988年Parasuraman，Zeithmal 及 Berry等三人針對影響顧客滿意的五個衡量服務品質的工具：有形性、信賴性、保證性、關懷性、反應性及1995年Jones and Sasser服務失誤發生時補救措施為問卷設計主要架構，以大高雄地區診所就醫婦女進行實地探究。主要模式架構最後則以LISREL進行整體適合度的檢定。
本研究結果發現跨區就醫比例仍偏高，由此可看出因地緣性的診所未必照顧得到該區的就醫者，就醫者寧願跨區就診反映了主要的關鍵因素所在，就醫者針對醫療服務過程發生失誤時，診所醫務行政人員所採取的補救措施及態度非常重視，因交通的便捷導致鄰近住家方便性的就醫情況會被其他因素所取代，醫療費用已非主要就醫選擇關鍵因素，避免過多的跨區就醫形成醫療資源的重複投資及浪費，管理式醫療在美國已被公認是最能控制醫療費用的利器，而英國預計於2004年4月前將所有基層醫療團體轉型成基層醫療信託，以充分利用基層醫療，避免過多的跨區就醫。本研究「再診意願」之關鍵因素結果將可提供開業醫做醫療服務上的參考，地方開業醫應思考如何在基本的醫療品質服務下開創獨特的醫療口碑創造令就醫者有再診意願的環境。

關鍵字:病患導向行銷 管理式醫療 醫療費用 知覺品質 醫師特質 服務補救 再診意願 轉診成本 醫療行銷

When the consumer’s behavior is change fatly and in hospital health care behavior is orient to customer-oriented marketing. Early in1983 the cooperator NCR use the consumer health care decision model by thronging questionnaire from the USA’s people every year, to understand healthcare marketing how to effect their hospital choice behavior and the Doctor’s personal Image. In 1999’s research shows that “to create new customer cost 10 times then old customer”, the same year Taylor and Cosenza in the hospital shopping model choice model ( HSMCM ) research find that owing the environment change so fast it let so many hospital and clinics closed. And patient must to out shopping and the medical resource exhaust.
We do not know how the future will be. However, to avoid investing money on purchasing the same medical equipment. Managed care has been considered as the effective weapon for controlling medical cost. The UK plans to transform basic medical groups to basic medical trust, which emphasizes family doctors, and encourage doctors to join a group practice so as to widely use basic medical equipment and Studying the key factors of the willingness of revisiting to. How can a local medical practitioner use the basic medical resource to create his unique words of mouth and an environment that patients will visit again? The research want to show that what factor is the key factor to let women wants to revisit the clinics when they need to be. The other purpose is avoid patients go to hospitals at other districts result of the medical equipment exhausts.
The result of the study in the big Kaohsiung area, which has 11 administration districts. The author by thronging questionnaire and use SPSS to research What’s the key factors in people’s mind. If knowing what’s they wants they should be good for patients. And Using LISREL as the main model structure to evaluate and the result shows the overall model of this study is goodness of fit. Patients cannot accept being neglected (the willingness of revisiting is 0% using cross analysis). Prefer to cost more expensive to attack what they really want, so the convenience owing near of house not the key factor of choose hospital. Instead of the recovery’s attitude. And the cost of care becoming the finial choice.
Can serve as a reference for practitioners to evaluate their medical service. It has a positive effect on patients as well as on doctors.

Key Words：customer-oriented marketing ，Managed care，cost of care，perception quality，doctor’s personal image，health care complaint recovery，the willingness of revisiting，the cost of switching hospitals ，health care marketing

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網路資源

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2. 行政院主計處網站: http://www.dgbas.gov.tw/

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