影響病人與醫師忠誠關係的中介變數：信任或滿意？

The Intervening Variable on Patient-Doctor's Loyalty Relations: Trust or Satisfaction?

許多研究已證實，信任與滿意皆會正向影響忠誠；但文獻上有關信任與滿意的關係卻有二種說法，一說滿意可透過信任的部分中介影響忠誠；另一說則認為信任可透過滿意部分中介而影響忠誠。本文據此歸納為二種比較模型，並利用結構方程式模型（SEM）進行結構模型驗證，期能找出較適用於醫療專業服務的解釋模式。研究以結構式問卷進行，對台北市一家大型教學醫院門診病人進行分層抽樣，總共收取1,024個樣本，有效樣本747個。經單一模型配適度檢定，二個模型大致都符合基本檢定標準，但進一步以複核效化分析（cross-validation analysis）進行模型比較後則發現，以滿意做為信任與忠誠之間中介變數的理論模型，具有較佳的預測與解釋能力，較適用於解釋專業性的醫療服務。

Previous studies have found out that trust, satisfaction and loyalty have positive integral nexus. Usually, there are two elements of loyalty: One based on equity theories-where trust becomes the intervening variable of satisfaction to loyalty; the other is based on social exchange theory-whereby satisfaction is considered the intervening variable of trust to loyalty. The question becomes: Between trust, satisfaction and confidence which element has the strongest intervening variable to loyalty in regards to health care services in Taiwan? Considering the previous studies and theories, this study uses the data of a teaching hospital to analyze the relationship among loyalty, trust and satisfaction with two competing models. Data from 1024 patients attending the hospital were collected by stratified sampling. 747 valid questionnaires were obtained after eliminating ineffective questionnaires. In addition, Structural Equation Model (SEM) was used to empirically explain the loyalty impulses between patient-doctor's relations. Using a single model fit test, our study found out that the two models confirm the basic testing criteria. Further cross-validation analysis found out that satisfaction was the intervening variable because it has higher/better prediction and interpretation in regards to patient-doctor's loyalty relations.