【背景與動機】：衛生主管機關推行「全民健康保險山地離島地區醫療給付效益提昇計畫」（Integrated Delivery System，簡稱IDS計畫），其初衷為力求提升山地離島地區民眾就醫可近性與增進醫療照護完整性，因過去甚少研究深入探討推行IDS計劃之民眾知覺醫療服務品質，故本研究進一步了解IDS計劃之民眾對醫療服務品質之重視度與滿意度。
【目的】：醫療服務品質的重要性在於除了會影響病患就醫滿意度之外，也會影響病患忠誠度。本研究之研究目的如下：1.了解偏遠地區民眾對醫療服務品質之滿意度與重視度。2.了解影響偏遠地區民眾醫療服務品質重視度與滿意度之相關因素。
【方法】：本研究針對高雄縣茂林鄉、那瑪夏鄉、桃源鄉過去一年曾有利用衛生所醫療服務或巡迴醫療服務者之當地居民，採便利取樣的方式進行資料的收集，並以SERVQUAL量表，採李克特五等尺度，進行問卷調查法。本研究共發出338份問卷，有效問卷為286份，有效問卷回收率為84.62%。以SPSS17.0套裝軟體進行樣本描述性分析、雙變項分析及迴歸分析。
【結果】：在就醫民眾對醫療服務品質之重視度方面，以”回應性"最受到重視(Mean=4.15，SD=0.689)，重視度最低者為”同理心”(Mean=4.039，SD=0.703) 。在就醫民眾對醫療服務品質之滿意度方面，以”保證性"讓就醫民眾最滿意(Mean=3.842，SD=0.723)，最低者為”有形性”(Mean=3.72，SD=0.703)。本研究發現「居住地」與「就醫交通時間」為影響重視度與滿意度之因素。在居住地方面，那瑪夏鄉之民眾重視度與滿意度顯著低於桃園鄉與茂林鄉。而在就醫交通時間方面，以30分鐘內之民眾其重視度與滿意度均顯著高於交通時間需2小時以上者。
【結論與建議】：由本研究之結果中可知，醫療服務品質之五個構面皆呈現負向缺口，其中缺口最大之構面是"回應性"，應優先改善至偏遠地區提供醫療服務之醫護人員專業技能訓練與應對禮儀訓練，以縮小回應性缺口。而居住在那瑪夏鄉之民眾對醫療服務品質之重視度或滿意度均較差，應進行整體改善。而交通時間較久者(2小時以上)，其重視度與滿意度亦均較低，建議應強化巡迴醫療以改善可近性與可用性。 【Background and Motives】
The Bureau of National Health Insurance (NHI) has implemented ”The National Health Insurance Project of Integrated Delivery Systems in Mountainous and Islet Districts” (IDS program) in order to improve the accessibility and wholeness of medical care in rural areas. Because of the less researches of health services quality in the past, this study tried to explore the importance and satisfaction of health services quality which are perceived by people in rural areas after the implementation of IDS program.
【Objective】
The importance of health services quality not only to influenced patients’ satisfaction, but also to affected patients’ loyalty. The objectives of the study are as follows: 1. To understand the patients’ perceived importance and satisfaction of health services quality in rural areas. 2. To explore the factors that influences the perceived importance and satisfaction of health services quality in rural areas.
【Methods】
The study adopted the SERVQUAL questionnaire with five-point Likert’s scale and convenience sampling to collect data. Objects were residents who lived in Maulin, Namashia and Taoyaun and looked for medical services in health centre in the past one year. 286 valid questionnaires were collected with a response rate 84.62%. After data collecting, the study adopted SPSS 17.0 to run the descriptive analysis, bivariate analysis and regression analysis.
【Results】
On the aspect of the importance of health services quality, the most important one of five dimensions is “Responsiveness” (Mean=4.15, SD=0.689), and the lowest important one is “Empathy” (Mean=4.039, SD=0.703). As for the satisfaction of health services quality, the most satisfied one of five dimension is “Assurance” (Mean=3.842, SD=0.723), and the least satisfied one is “Tangibles” (Mean=3.72, SD=0.703). The results show us that “place of residence” and “transportation time” could significantly influence patients’ perceived importance and satisfaction. The residents who lived in Namashia perceived significantly lower importance and satisfaction of health services quality than residents who lived in Maulin and Taoyaun. The residents who spent less then thirty minutes to clinic perceived higher importance and satisfaction of health services quality than those who spent more then two hours.
【Conclusions and Suggestion】
The results show that there are all negative gaps of five dimensions of health services quality. The biggest gap of five dimensions of health services quality is “Responsiveness”, the administrators of hospitals and health centres should improve the professional skill and manner of all medical staffs first in order to minimize the gap. The study also suggests that the managers should improve the whole health services quality in order to raise the perceived importance and satisfaction by residents who live in Namashia. In addition, the residents who spent more then two hours to clinic percived lower importance and satisfaction of health services quality. Health services providers should provide more mobile health services to improve the accessibility and usability of health services.
