病人對醫師與院信任、滿意忠誠之關係

The Relationship among Trust, Satisfaction and Loyalty in Professional Medical Services: the Case of Taiwan

信任對象可分為個人層次及系統層次，二者之間會相互影響。顧客對服務提供者（或機構）的信任，除了直接影響忠誠外，同時亦間接透過滿意影響忠誠。此外忠誠具有轉移能力，對服務提供者正向的忠誠關係，會直接轉移成為對企業的忠誠。台灣的醫院屬於封閉式醫療體系（close system），絕大多數醫師由醫院所雇用。門診病人就醫選擇的考量因素包括醫師（個人層次）與醫院（系統層次）。本文從信任、滿意與忠誠關係之觀點，檢視病人對不同信任對象（醫師與醫院）的因果關係是否不同，並探討忠誠的相互移轉作用及其影響強度。本研究以分層抽樣方法針對台灣北區某家醫院門診病人進行問卷調查，並以結構方程模型（structural equation modeling; SEM ）進行結構模型（structure model）驗證。研究結果發現，無論信任對象是醫師或醫院，滿意在信任與忠誠之間皆有中介功效，其因果關係亦類似。而忠誠的移轉與延伸效果確實存在。病人對醫師與醫院的忠誠會相互移轉，其中對醫師忠誠的影響力則強於醫院。

The object of trust between physician-patient relations revolve around individuals (physicians) and systems (hospitals). This paper aims to compare the various physician-patient relationship modes of these entities with the same patient and two distinguished trustees (a doctor and hospital) at the same time. This paper also explores the influential power over loyalty in view of affective trust, cognitive trust and satisfaction, and expects to verify the mediator pattern of satisfaction between trust and loyalty. The study poses: Is there a discrepancy between two active modes of medical services—physicians-hospitals? In this study, a stratified sampling method was used to collect data. Participants were outpatients of a large teaching hospital in northern Taipei city. In addition, a structural equation model(SEM) is used for theory testing and development. The results show that whether the object is a physician or hospital, affective trust, cognitive trust and satisfaction had a significant positive effect on loyalty. Satisfaction, in particular played an important intervening role in both affective trust-loyalty relationship and cognitive trust–loyalty relationship. Patients’ loyalty, on the other hand; did have a diversion and extension effects between a physician and hospital. Loyalty diversion at individual level (physician) and systemic level (hospital) was bilateral. In terms of intensity, loyalty diversion from physicians to hospital was stronger compared to loyalty from hospital to physicians. Patients’ trust varies based on the level of target.