探討病人忠誠度、價值共創行為，以及使用健康照護服務之意圖

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研究生：	謝佩珊 Hsieh, Pei Shan
論文名稱：	探討病人忠誠度、價值共創行為，以及使用健康照護服務之意圖 Patient Loyalty, Value Co-creation Behavior, and Intention to Use in Healthcare Service Contexts
指導教授：	林福仁 Lin, Fu Ren
口試委員:	陳家祥胡仁華嚴秀茹王貞雅
學位類別：	博士 Doctor
系所名稱：	科技管理學院 - 科技管理研究所 Institute of Technology Management
論文出版年：	2015
畢業學年度：	103
語文別：	英文
論文頁數：	222
中文關鍵詞：	病人忠誠度、價值共創、病人體驗、服務接觸
外文關鍵詞：	Patient loyalty, value co-creation, patient experience, service encounter
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在論人計酬支付制度之下，根據被保險人過去兩年的健保醫療支出，訂定當年度的健保支出額度。如果當年度的健保支出低於額度，結餘的經費就成為醫院的盈餘；反之，若醫療支出高於額度，則多出來的費用，照護的醫院要自行吸收。目前在台灣，病人被授予可以自由選擇不同的健康照護提供者。因此，對於實施論人計酬支付制度的醫院而言，如何讓其分配到的病人能忠誠地使用其服務至關重要。本研究探討論人計酬支付制度中的兩大議題：病人忠誠度以及病人和醫院之間的資訊不對稱。
本論文包含三大主題，安排如下：首先，我們以病人忠誠度，病人體驗，服務接觸和病人價值共創行為來解釋所提出來的概念性模型。第二個主題的目的是要解釋病人在健康照護情境下，對於醫院的不同服務接觸所認知的服務品質，以及關於醫院形象的認知，是否會影響他們的價值共創行為。第一和第二個主題的樣本資料來自於台灣北部區域教學醫院（耕莘醫院）之不同門診的病人。第三個主題則以情境為基礎的實驗法，調查病人在知道醫院實施論人計酬制度，以及他們歸屬於該醫院照護的病人時，使用該醫院服務的意圖。
本論文研究發現病人在不同的服務接觸點會因其公民行為之不同有不同的忠誠度表現；同時，在所獲得的價值與對醫院的信任在不同的服務接觸點也會影響病人共創價值的行為。在醫病資訊不對稱的情況下，從情境的實驗的結果得知醫院主動發出論文計酬支付制度以及健康照顧服務的資訊，對於病人就診意願有顯著的影響。從研究結果，健康服務提供者如醫院可以配置服務資源在不同的服務接觸點以獲得更好的病人忠誠度與共創價值的行為表現。發布病人為中心的健康照顧資訊（如: e-health）與機構服務資訊（如: 論人計酬支付制度），可以增進病人就診的意願。因此，本研究的發現除了在學術的理論上有所增進外，對於健康服務的實務上，也有具體的參考價值。然而，本研究的結果僅在某一段時間內中所獲得的資料，未來可以發展病人行為模式的縱貫性研究。

Patient loyalty is crucial within a capitation payment scheme, especially when patients are granted freedom to choose among alternative providers, e.g., in Taiwan. A service provider can take the part of the amount paid as profit if the patient uses few services, and has to absorb the excessive expenses if the patient consumes services the cost exceeding the reserved. As a result, the success of the capitation payment scheme needs to tackle two major issues patient loyalty and the information asymmetry between patients and the hospital.
This dissertation includes three main themes organized as follows. First, we explain the proposed conceptual model along with relevant research pertaining to patient loyalty, patient experience, service encounter and patient co-creation behavior. The aim of the second theme is to justify the role played by each encounter of perceived service quality and hospital image in the explanation of co-creation behavior in the context of the healthcare services offered by a hospital. We collected data about patients of different clinics in a regional hospital (Cardinal Tien Hospital: CTH) in northern Taiwan for the first and second theme. Finally, in the third theme, through the scenario-based survey method, we investigate patients’ revisit intention to a hospital after they know about their affiliation with the specified hospital via the capitation system.
This research discovered that patients’ experiences in different healthcare service encounters with different patient citizenship behaviors affect the loyalty to the corresponding service providers (e.g., hospitals). Patients’ perceived value and trust from different service encounters also affects their value co-creation behaviors. From the scenario-based survery, we identified that siganaling instittuionalized service information and the patient-centered care service information policy significantly affect patients’ intention to use the service provided by the healthcare service provider comparing with signialing no or either one information item. The results imply that a healthcare service provider such as a hospitial can allocate resources for different service encounters in order to maintain patients’ loyalty and value co-creation behaviors. The provision of the information in institutationlized service (e.g., capitation payment scheme) and the patient-centered service (e.g., e-healthcare service) could increase patients’ intention to use the services provided the healthcare service provider. In summary, this research contributes not only to the academic literature but also to the managerial implications to healthcare service. However, the findings of this study are obtained only in a snapshot of a time flow. There is a need for longitudinal studies to develop patient behavior model in future.

摘要    I
ABSTRACT    II
謝誌    IV
TABLE OF CONTENTS    V
LIST OF TABLES    VIII
LIST OF FIGURES    X
CHAPTER 1 INTRODUCTION    1
1    RESEARCH BACKGROUND    1
2    RESEARCH MOTIVATIONS    3
3    RESEARCH OBJECTIVES    5
CHAPTER 2 THEME I:  EXAMINING THE MODERATING ROLE OF PATIENT CITIZENSHIP BEHAVIORS FOR PATIENT LOYALTY IN CAPITATION PAYMENT SYSTEMS    9
1    RESEARCH QUESTIONS    9
2    LITERATURE REVIEW    13
2.1 Conceptualization of Patient Loyalty    13
2.2 Patient Experience and its Effects on Loyalty    14
2.3 A Service Encounter Perspective of Patient Experience    17
2.4 Patient Citizenship Behaviors    19
2.5 Gaps and Motivation    22
3    RESEARCH MODEL AND HYPOTHESES    22
3.1 Patient Experience in Service Encounters and its Impacts on Loyalty    23
3.2 Patient Experience in Clinical Service Encounter and its Impacts on Loyalty    24
3.3 Patient Experience in Follow-up Care Encounter and its Effect on Loyalty    25
3.4 Moderating Role of Patient Citizenship Behaviors    26
4    STUDY DESIGN AND DATA COLLECTION    29
4.1 Studied Hospital    29
4.2 Measurements    29
4.3 Data Collection    31
5    ANALYSIS AND RESULTS    31
5.1 Reliability and Validity of Measurement Items    33
5.2 Model Test Results    35
6    DISCUSSION    39
6.1 Research Contributions    40
6.2 Managerial Implications    41
7    CONCLUSIONS AND FUTURE RESEARCH    42
CHAPTER 3 THEME II:  EXAMINING THE MODERATING ROLE OF CORPORATE IMAGE IN WEIGHTED QUALITY OF HEALTH SERVICE ENCOUNTERS, EXPERIENCES, AND VALUE CO-CREATION    43
1    RESEARCH QUESTIONS    43
2    LITERATURE REVIEW    47
2.1 Value Co-creation in Healthcare    47
2.2 Weighted Quality of Health Service Encounters    48
2.3 Corporate Image    55
2.4 Gaps and Motivation    57
3    RESEARCH MODEL AND HYPOTHESES    58
3.1 Patient Experience and Value Co-creation Behavior    59
3.2 Weighted Quality of Health Service Encounters and Experience    60
3.3 Mediation Effects    62
3.4 Moderating Role of Corporate Image    63
4    STUDY DESIGN AND DATA COLLECTION    65
4.1 Sample and Data Collection    65
4.2 Measurements    66
5    ANALYSIS AND RESULTS    70
5.1 Validity and Reliability    70
5.2 Hypotheses Test Results    72
5.3 Moderator Analyses    74
5.4 Mediation Analyses    76
6    DISCUSSION    79
6.1 Research Contributions    79
6.2 Research Implications    81
7    CONCLUSIONS AND FUTURE RESEARCH    82
CHAPTER 4 THEME III:  TO KNOW OR NOT TO KNOW IS A BIG QUESTION: THE IMPACT OF SIGNALING EFFECT ON PERCEIVED VALUE, TRUST AND INTENTION TO USE    84
1    RESEARCH QUESTIONS    84
2    LITERATURE REVIEW    88
2.1 Information Asymmetry and Signaling Theory    88
2.2 Institutionalized Service Information as the Signal    92
2.3 Patient-centered Care Service as the Signal    94
2.4 Perceived Value    96
2.5 Trust    97
2.6 Intention to Use    98
2.7 Gaps and Motivation    99
3    RESEARCH MODEL AND HYPOTHESES    100
3.1 Patient Perceived Value and its Impact on Intention to Use    100
3.2 Trust and its Impact on Intention to Use    102
3.3 Perceived Value and its Impact on Trust    102
3.4 Signaling and its Impacts on Perceived Value    103
3.5 Signaling and its Impacts on Trust    104
3.6 Mediation Effects    106
4    RESEARCH METHODS    107
4.1 Overview and Conceptual Research Flow    107
4.2 Measurements    108
4.3 Experimental Design    110
4.4 Pretest: selection of patient-centered care service    111
4.5 Pilot Test    114
4.6 Manipulation Check    115
4.7 Order Effects    118
4.8 Main Study    120
5    ANALYSES AND RESULTS    121
5.1 Descriptive Data Analysis    122
5.2 Validity and Reliability    124
5.3 Hypotheses Testing    125
5.4 Effect of the Scenarios    137
6    DISCUSSION    139
6.1 Research Contributions    140
6.2 Research Implications    141
7    CONCLUSIONS AND FUTURE RESEARCH    144
CHAPTER 5 SUMMARY OF RESULTS AND MANAGERIAL IMPLICATIONS    146
1    SUMMARY OF RESULTS    146
2    IMPLICATIONS AND FUTURE RESEARCH    149
REFERENCES    153
APPENDICES    181
APPENDIX A MEASURES FOR THEME I    181
APPENDIX B MEASURES FOR THEME II    183
APPENDIX C QUESTIONNAIRE    185
APPENDIX D COMPARISON OF SERVQUAL AND WQOHSE    192
APPENDIX E CAPITATION PILOT PROJECT    193
APPENDIX F STRATEGY OF CAPITATION PILOT PROJECT    197
APPENDIX G MEASURES FOR THEME III    199
APPENDIX H PRETEST QUESTIONNAIRE    200
APPENDIX I PILOT TEST QUESTIONNAIRE    204
APPENDIX J MANIPULATION CHECK QUESTIONNAIRE    210
APPENDIX K FORMAL TEST QUESTIONNAIRE    217

                                

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