全民健保民眾就醫流程經驗與治療效果滿意度之相關：2012—2016年我國全民健保就醫權益調查為例

Relationship between patient procedure experience and treatment outcome satisfaction by using 2012-2016 annual National Health Insurance survey data

目標：探討以基層醫療或醫院的就醫流程經驗中哪些因素與治療效果滿意度有關。方法：資料來源為「101—105年全民健保民眾就醫權益長期監測系統之研究」，此研究以各年度橫斷面調查方式進行。問卷採用安德森架構，整合五年資料為同一樣本群體，依門診與醫院分成兩群進行後續分析，導入邏輯斯迴歸分析探討影響病人的就醫治療結果滿意度的相關因素。結果：民眾就醫經驗中與醫師之間的互動是相當重要影響治療結果滿意度的因素，有高達六或十倍以上的勝算比會比不滿意者表示滿意其治療效果，醫護人員如果有提供衛教指導也會有將近兩倍的勝算比，然不同求醫行為仍有其他影響因素。結論：影響滿意度核心因素仍然是民眾看診的經驗，醫病信任關係、醫療訊息傳遞與決策共享過程的品質皆是影響民眾總體感受的因子。台灣健保正邁向階段性成熟整合期，透過政策技術創新與倡議增加民眾互動的誘因，進而改善民眾就醫流程經驗與滿意度，逐步邁向醫病關係公平效率觀感及多方參與度的提升。（台灣衛誌2020|39(3)：257—268）
Objectives: Identify factors influencing patients' satisfaction with outcomes of medical treatments of primary or hospital care. Methods: This study used data from the 2012-2016 annual National Health Insurance (NHI) surveys, which explored patient experiences related to receiving of medical services. The questionnaire was created on the basis of Andersen's model. We considered that data from every survey year in the multiyear survey database were independent and representative of the population. Logistic regression analysis was introduced into the research to explore relevant factors influencing patients' satisfaction with treatment outcomes. Results: Doctor-patient interaction with regard to outpatient services was a crucial factor influencing patients' satisfaction with treatment outcomes. Such an interaction was associated with a high likelihood of satisfaction with treatment outcomes (odds ratio = 6–10, p<0.001). Moreover, implementation of health education by medical staff was another factor concerning the likelihood of satisfaction with treatment outcomes (OR = 1.4–2.0| p<0.001). Nonetheless, influential factors may vary for different medical-seeking behaviors. Conclusions: Treatment-seeking experience is the key factor influencing patient satisfaction. Other factors influencing people's overall satisfaction include the doctor–patient trust, the quality of medical information delivery, and shared decision-making processes. Taiwan's NHI is entering a stage of maturity and integration, where innovative initiatives on policies and technologies serve as incentives to increase interaction with the public, thereby improving people's procedure experience and satisfaction with medical care, achieving positive perceptions of fairness and efficiency in a doctor–patient relationship as well as increased participation of various parties. (Taiwan J Public Health. 2020|39(3):257-268)