由於醫師與病患個人背景的不同、健康保險制度的規範與醫療進行時的情境不一，兩者對於醫療服務的知覺將產生差異。差額負擔是健保局基於法令要求、使用者付費與控制醫療費用所提出之醫療政策，其目的在降低醫療費用的成長。本研究主要在探討差額負擔在醫師與病患知覺與期望上的差異程度；另外，病患對差額負擔的期望與知覺服務水準的缺口所造成的醫療滿意度的改變，也是本研究的主要目標之一。
本研究採取橫斷式研究法，以南部地區六十五家健保特約醫院住院病患及醫師為問卷調查對象，資料取自當時兩個月內該院出院之患者或家屬所提供之意見，以探討醫師與病患對差額負擔知覺上的差異與影響病患醫療滿意度的因素，進行各種統計分析。
藉由深入探討病患與醫師因為就醫情境、個人需求及過去經驗不同所產生之知覺差異程度；並且進而比較兩者期望與知覺醫療服務品質程度的缺口所造成對滿意度的影響；藉以提供中央健保局相關差額負擔滿意度的影響因素，以利該項業務未來推展上的助益。

Due to the background discrepancy, the regulations of healthy insurance, and the different situation of medical service, there is different perception of balance billing between patients and physicians. The promotion of balance billing is based on the request by law, paid by the users, and medical budget control, which can lead to lower growth rate of medical fee. The purpose of this study is not only to reveal the difference of perception of balance billing between patients and physicians, but also to find out the relationship between service satisfaction and perception gap.
Cross-section research method was used to investigate the opinions of admitted patients and physicians in 65 hospitals, located in southern Taiwan and affiliated with the Bureau of National Health Insurance, by questionnaire during a 2 months period. We’d performed various statistical analyses in order to identify the different perception between patients and physicians, and the relationship between perception gap and medical service satisfaction.
After extensive research on the related factors, including medical service situation, individual need, and past experience of patients, we can predict their expectation to balance billing. Besides, the discrepancy of expectation and perception between patients and physicians can cause the satisfaction gap, which may influences medical service satisfaction. Our results provided the related factors of satisfaction to the Bureau of National Health Insurance, in effort to help the promotion of balance billing.

目 錄 I
圖目錄 III
表目錄 IV
第一章、緒 論 1
第一節、研究背景與動機 1
第二節、研究目的 1
第二章、文獻探討 3
第一節、差額負擔的定義與健保局相關法令規定 3
第二節、知覺、行為相關理論與差額負擔 12
第三節、相關病患健康保險差額負擔意願的研究 14
第四節、相關病患滿意度的研究 21
第三章、研究方法 36
第一節、研究假說 36
第二節、研究架構 37
第三節、研究樣本及資料來源 38
第四節、變數之操作型定義與型態 40
第五節、分析方法 58
第四章、結 果 60
第一節、樣本代表性檢定 60
第二節、醫師與病患基本資料分析 62
第三節、病患就醫情境、個人需求與過去經驗對期望醫療服務的影響 71
第四節、病患滿意度 78
第五節、病患個人需求、就醫情境、過去經驗與對差額負擔期望的關係 79
第六節、醫師與病患在差額負擔期望與知覺上的差異 82
第七節、病患在差額負擔期望與知覺上的缺口與服務滿意度的關係 83
第五章、討論 86
第一節、醫師與病患基本資料討論 86
第二節、醫師與病患對差額負擔的期望與知覺差異 89
第三節、病患就醫情境、個人需求與過去經驗對期望醫療服務的影響 92
第四節、知覺期望缺口與病患滿意度 94
第六章、結論與建議 96
第一節、結論 96
第二節、建議 97
I
第七章、參考文獻 98
中文部份 98
英文部份 100
附件 108
醫師問卷 108
病患問卷 111

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