全民健保實施帶來醫療服務化轉型，本研究在「以病患為中心」思維下，根據產業觀察與相關文獻理論基礎，輔以Zineldin（2006）所提出的5Qs model進行問卷調查，探討病患在就醫過程中對各項服務品質構面之重要程度與滿意程度，最後藉由實證研究結果建構體外震波碎石術特殊利基市場之競爭定位與因應策略，尋求醫療服務差異化之獨特價值。
實證結果可知，手術採住院治療者滿意度與忠誠度明顯比門診治療者高， 「氣氛品質」、「基礎設施品質」對病患滿意度有顯著正向影響，「互動品質」、「氣氛品質」對病患忠誠度有顯著正向影響；本研究推展出由醫師提供「專業的醫療服務」，發展病患「獨特的體驗價值」，最後達到「滿意的口碑行銷」等核心價值。
競爭策略包含（1）從標準化到差異化：以標準作業化流程在病患心中建立差異化價值；（2）從醫療本位到病患優先：以病患為導向，親切互動溝通，滿足情感知覺服務；（3）從傳統模式到創新服務：以創新流程設計打破固有模式，推展具有持續競爭優勢之醫療服務；（4）從封閉資訊到開放互動：強調醫生專業價值，打破資訊不對稱，建立醫病信賴關係。針對體外震波碎石術之策略定位為「親切有效快速的整合醫療照護服務」，而成立「體外震波碎石中心」將是有助於此一目標達成之可行方案。

The enforcement of national health insurance brings the new transition of medical service. The main purpose of this study is to investigate patients’ emphasis and satisfaction on different dimension of service quality. The study referred to industrial views, related literature review and 5Qs model (Zineldin, 2006). Eventually, the practical research results are used to conduct a competitive niche strategy and a positioning plan of extracorporeal shock wave lithotripsy market to seek the unique value of medical service differentiation.
According to the empirical view, the satisfaction and loyalty of those patients who had operations under the hospital treatment were significantly higher than those patients who didn’t. “Quality of atmosphere” and “Quality of infrastructure” were the two factors which had positive impact on the satisfaction of patients. Also, “Quality of medical care interaction” and “Quality of atmosphere” affected the loyalty of patients greatly. Therefore, this study suggested that doctors should provide professional medical services to offer unique attributes which were valued by patients, and then achieved the influence of word-of-mouth marketing.
The Competitive strategy is (1) from standardization to differentiation: creating values to patients by standard operation procedure. (2) from selfish departmentalism to patient-orientation: providing more interactions during medical service to fulfill the cognitive and emotional needs of patients. (3) from tradition to innovation: carrying out a new model which was designed by whole new ideas to supply medical service with sustainable competitive advantage. (4) from closed to open environment: emphasizing on profession and abandoning asymmetric information to develop trust relationship between doctors and patients. The strategic positioning of ESWL is to provide cordial, effective and fast integrated medical service for patients, and the establishment of “Shock Wave Lithotripsy Center” is the further step of this strategy.

論文提要 I
摘 要 II
ABSTRACT III
致謝詞 IV
目 錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第三節 研究流程 5
第二章 產業現況與文獻探討 7
第一節 體外震波碎石術 7
第二節 消費者選擇醫療服務之因素 15
第三節 醫療服務品質 19
第四節 病患滿意度 28
第五節 競爭策略 30
第六節 競爭優勢 34
第三章 研究方法 39
第一節 研究架構 39
第二節 研究變項之操作性定義 40
第三節 研究工具 42
第四節 研究對象及資料蒐集 43
第五節 資料分析方法 43
第四章 實證結果與分析 46
第一節 樣本結構 46
第二節 服務品質 47
第三節 信度分析與因素分析 51
第四節 變異數分析 53
第五節 多元迴歸分析 64
第六節 管理意涵 67
第五章 競爭定位與因應策略 70
第一節 以病患為中心 71
第二節 從實證結果修正競爭定位 73
第三節 持續性競爭優勢 77
第四節 競爭策略與定位 82
第六章 結論與建議 87
第一節 結論 87
第二節 建議 89
參考文獻 92
附錄 101

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三、網站部分
1. 中央健康保險局，http://www.nhi.gov.tw/ .
2. 全民健康保險醫療費用協定委員會，http://www.doh.gov.tw/ .