目的：在台灣醫學中心林立，部分病人包括眼疾患者皆有特殊的就醫習慣，一旦發病就會直接到醫學中心求診，原因乃是相信其擁有優秀的醫師素質與新穎的儀器設備。另一方面部分連鎖經營的眼科診所也具有超強的行銷能力與優質的醫療服務，加上眼科疾病一般無致命性，不少患者在衡量整體時間因素與就醫的方便性後，多以眼科診所為其首選，其服務量甚至超越醫院。在醫學中心與眼科診所各有其優勢的眼科特殊醫療生態，兩強並立的現象和其他科別是不同的，而區域醫院眼科在兩強之間處於相對弱勢。以往文獻未能將此兩強一弱的特殊性加以研究，本論文將首次探討此現象，並為區域醫院眼科，提供一個制定經營策略的指標。
方法：以Andersen 所提出的醫療服務利用的行為模式為架構，輔以其他文獻，參考整個就醫行為與醫療利用間的動態與循環概念，將眼疾病人的求診模式分為環境因素、人口學特質、健康行為與健康結果等四項，再加上如何達到病患滿意度與塑造醫院形象兩項，合計六大項之問卷表格。於2013年9至12月間，在高屏地區的多家醫學中心、區域醫院與診所進行調查，共得到300份問卷，並加以進行描述性分析與迴歸分析。
結果：本研究發現眼疾患者會有以下的求診行為：全民健保的部份負擔還是會影響病患的就醫考量、有醫療險而必須住院接受白內障手術者會以區域醫院為首選、高屏地區患者少有跨縣市就醫現象(可能和眼疾多為輕症有關)、病情嚴重時有一半的病患願意忍受較久的候診時間、高達九成病患不會因為給藥的多少來選擇就醫場所、七成患者會到固定的醫療院所找固定眼科醫師、就醫行為在相連兩次的選擇中表現出高度的忠誠度、患者選擇醫療院所的三大考量（醫術醫德、交通便利、親友推薦）、九成病患會採納親友推薦、患者醫藥資訊的來源主要是新聞媒體、患者選擇診所的主要原因是離家近、眼疾患者選擇醫學中心的主要原因是其它醫師的轉診、一旦有嚴重的眼疾時將近一半患者會選擇醫學中心、患者其就醫頻率最常見者是每三個月內就診1至2次、而每月就診一次者多為白內障與青光眼等慢性病、眼疾病患就醫的目的是不瞭解自己得了何種病而必需由醫師來解決、若只要拿保養眼藥水五成病患會選擇比較省時間的診所、而診所不收掛號費的優待策略僅能吸引三成民眾、大型醫院針對特殊族群優待策略可以吸引五成的病患、高屏地區患者就醫以現場掛號居多、患者會根據醫療院所的三大形象﹙由親友口碑、電視宣傳、報紙宣傳獲知﹚做出抉擇、病患的滿意度與醫院形象會影響其就醫忠誠度，進而影響就醫選擇。有了以上發現，相信對於區域醫院眼科製訂相關策略時是有所助益的！
結論：區域醫院眼科經營的管理策略，其過程必須完整、詳實與創新。除了短期的經營目標及優先順序必須明確外，中、長期的發產方向，更應取得一致性與前瞻性的共識。除了必須先確認醫療環境中的重大影響因素外，關鍵性資源之獲得與分配、價值活動的執行內容與方式、引進創新的管理系統與醫療技術、注重核心能力與機會佔有率、強調醫療機構合作與聯盟的重要、有效的進行市場區隔與形成差異化優勢等，都是必須列為競爭策略的思維。

Objective: Lots of patients with any ocular problems were used to seek for treatment in the medical centers directly in Taiwan. The reason is that they believed there are more outstanding physicians and advanced equipments to be found. Beside, some franchise ophthalmologic clinics have stronger marketing abilities and provide excellent service. In fact, most of the ocular diseases are not serious and fatal. Because of the longer wating time and inconvient in all medical centers, patients often seek for help from local clinics at first. As a result, the benefits of ophthalmologic clinics and medical centers are obvious. Therefore most patients would neglect the role of regious hospitals. How to struggle between two superpower (medical centers and clinics) became the challenge of regional hospitals. According to the previous literature, no associated researches in this particular phenomenon were found. To increase the competitiveness and to survive, hospitals need to make policy to be aware of the demand in the healthcare market. In this pilot research, we aimed at the strategic managenent of ophthalmologic division of regional hospital which may promote the competitive advantage.
Methods: Based on the behavior patterns of medical care proposed Anderson and others, we will focus on the dynamic and cyclic concept of the utilization of patients with ocular diseases. According to the early reports, the newly modified behaviors of seeking medical service of patients were studied. In our study, six items including environmental factors, demographic factors, healthy behaviors, healthy results, patient’s satifaction and hospital image were added in the designed questionnaire. This survey was implemented in several medical centers, regional hospitals and ophthalmologic clinics in Sourthern Taiwan (Kaohsiung and Pingtune) between September and December in 2013. The results were recorded and analyzed by using descriptive statistic and linear regression which employed to test the medical relationships among variables and how variables related to patient's loyalty.
Results: Total 300 samples are collected and the preference of choice of hospital, the patient’s satisfaction and hospital image were explored. First, the partial burden of National Health Insurance would partly the consideration of seeking medical service. Secondly, patients with cataracts who needed operation would go to the regional hospital for admission with the support of private healthy insurance. Because the common ocular diseases were mild, patients would not like to move to remote and bigger hospitals. If the illness of eyes were serious, half of patients are willing to longer waiting time for further evaluation and treatment. Nearly 90% of patients did not care about the amount of eye-drops which was given by doctors. About the patient’s loyalty, 70 % of patients would visit the same hospitals or doctors according to their past experience. Even the first visiting time of treatments was not effective, they also came back to the same one. There are three factors which would impact on the choice of patients with ocular diseases included the professional skills of physicians, convenience, and recommendation from the relatives and friends (near 90%). The medical information was mainly obtained from TV media. The main reason of choosing the clinics is due to the closer distance from they lived. The possibility of seeking for medical centers is the referral system from local ophthalmologists. Half of this group was bothered by trouble eye problems. The frequence of consulting doctors is almost 1-2 times within three months. However, patients with cataracts, glaucoma and other chronic illness, they may visit the doctors in clinics just for drugs in each month. If patients only needed the regular medication for controlling cataracts and glaucoma, they may choose the clinics due to the shorter waiting time. It is wonderful that only 30% patients appreciated the free charge about registration fee in clinics. However, the discount of fee in bigger hospitals for special populations may attract 50 % patients with ocular diseases. In Sourthern Taiwan, the peculiar habits of outpatients waiting in the line to register were noted since early morning. They seldom got used to the help from telephone and morden internet to make reservation. In addition, the patients emphasized on three excellent traits about hospital image including reputation from their relatives, promoting messages from TV programs and newspapers in their mind. Finnaly, the good patient’s satifaction and best hospital image would influence on the loyalty of many patients.
Conclusion: Under the pressure of increasingly fierce competition in regional hospitals, all the managers should pay greater attention to the preference of patient’s choice of hospital and the quality of medical service. The process of strategic management must be completed, detailed and innovative. Beyond the short term business target and sequence of priority, the mid- and long term goals must be arranged at the beginning of plan. Moreover, consistency and provative perseptive have to be achieved. At first, we must recognize the significant influential factors in this medical environment. The other strategic goals included the gain and distribution of critical and important resources, the implement and methods about valuable activities, introducing the system of new management and medical technology, focusing on the core capacity and market share, emphasizing the importance of collaboration and alliance between clinics and medical centers, categorizing market segmentation and the strategic differentiation. Our studies strongly suggested that only good strategy may induce the good patient’s satisfaction and promote the best hospital image which cound improve the permanent development of the department of ophthalomoly in regional hospitals.

目錄
論文審定書................................................................................................ⅰ
論文提要...................................................................................................ⅱ
誌謝..........................................................................................................ⅲ
中文摘要.................................................................................................. ⅳ
英文摘要.................................................................................................. ⅵ
目錄......................................................................................................... ⅸ
圖次........................................................................................................ ⅺ
表次....................................................................................................... ⅻ
第一章 緒論..............................................................................................1
第一節 研究背景及動機..............................................................................1
第二節 問題的陳述與研究的貢獻...............................................................4
第三節 研究的流程與設計........................................................................ 5
第二章 文獻探討....................................................................................... 6
第一節 五力之分析................................................................................. 7
第二節 價值鏈的觀念與競爭策略.............................................................. 10
第三節 Brandenburger的價值網的觀念...................................................... 14
第四節 SWOT 分析模式.......................................................................... 17
第五節 以資源基礎觀點來分析眼科醫療環境.............................................. 25
第六節 平衡計分卡的應用在區域級醫院眼科之運用................................... 27
第七節 競局說的新觀念應用(「醫院聯盟」的敵我合作概念)....................... 33
第八節 醫療機構經營的「最優化」的三大要素.......................................... 36
第九節 病患選擇醫療院所之模式與其特性之分析....................................... 37
第十節 醫療行銷與病患忠誠度................................................................. 45
第三章 台灣地區醫療產業的市場特色與眼科最常見疾病之簡介................... 51
第一節 台灣地區現有健保制度對眼科經營之影響....................................... 51
第二節 台灣現有醫療環境特色與眼科經營之特殊性................................... 54
第三節 台灣地區最常見眼疾之簡介與最新治療狀況................................... 56
第四章 研究方法與設計............................................................................. 72
第一節 研究架構與研究流程圖................................................................ 72
第二節 研究變相的操作型定義................................................................. 76
第三節 資料分析..................................................................................... 78
第四節 研究限制與對後續研究者的建議.................................................... 79
第五章 研究結果....................................................................................... 82
第六章 結論與建議.................................................................................. 103
參考文獻.................................................................................................. 107
中文部份................................................................................................ 107
英文部份................................................................................................ 110
附錄一...................................................................................................... 112
附錄二...................................................................................................... 119
附錄三.................................................................................................... 120
附錄四..................................................................................................... 122

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二、英文部分
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