在生命科學、醫藥和醫療保健等技術突破的幫助下，人類壽命的質與量均較前進步，這個世紀的人們將是共同見證｢長壽｣的第一批人類。全世界已開始邁入老年化社會結構，人類可以大幅的延長壽命，但在延長壽命的過程中，我們必須仰賴良好的醫療技術及服務來維持優質的生命品質，如此一來不僅對醫療服務的需求增加，同時對醫療服務品質的期望與要求也愈來愈高。台灣自1995年3月起全面實施全民健康保險，此舉大大地降低了民眾就醫的經濟障礙，使得社會大眾對於醫療服務品質的期望更為殷切，同時也加劇醫療市場的競爭。

	而醫療服務業在服務設計與服務專業上有別於一般服務業，基本上製造業產品行銷有４Ｐ:即Product(產品)、Price(價格)、Promotion(推廣)以及通路(Place)﹔根據Booms及Bitner(1981)兩位作者的報告﹐認為有關服務業的服務模式(Service Model)，除傳統製造業的４Ｐ外，還要加上３Ｐ，也就是:參與者(Participants)：包括提供服務者及接受服務的人；有形物証(Physical evidence)：不管就提供者或接受者角度，服務所提供的雖然不像產品那麼具體但是也是實質存在的；服務過程的組合(Process of service assembly)。服務業強調服務的過程，所以服務的模式除了有參與者和實質提供的服務性產品外，還要受「服務的過程」多所影響。

	然而，一般的服務業接受服務者在程度上或多或少能參予或有能力提供意見，而醫療服務業則不一樣，提供服務的人比較獨裁(專業掛帥)，要如何提供服務但憑自身專業，而接受服務的人能商榷的空間有限，所以基本上醫療業是一個專業法西斯(林永福，2002)，不過因近年來醫學知識以及消費者主動性(active consumer)觀念(Brantes 2001)的普及，民眾參予醫療計劃訂定及實踐的比重亦愈來愈高。

	儘管有愈來愈多的學者在開始探討服務業，但多專注於商品交易過程的服務品質，而在服務接受者和服務傳遞者互動程度較高之產業（譬如醫療業）則較少著墨。事實上，顧客在醫療服務的過程中，除了希望得到產品或服務本身所提供的部分，同時也希望充分享受一個有價值的經驗。但是國內對於醫療人員、病患之間溝通的實證研究則付之闕如，現有的文獻多集中在當家屬面臨重症危急病人時所產生的壓力和調適過程，以及如何滿足病患在認知、情感和社會等不同層次的需求，以改善病患家屬的焦慮和壓力（劉盈君等，1999；黃瑞美等，1997）。本研究之研究目的是促使醫療院所在面對激烈的變動環境下，以較適合的因應方式應對病患，對顧客建立起一對一的醫病互動關係，不但可以維持現有的顧客、贏得新的顧客，並能提昇顧客對於醫療院所的顧客滿意度，更期望因此而提高醫院的獲利貢獻程度。

Assist by technology breakthrough on Genetic Science, Medicine and Healthcare, human being has a great improvement on life itself and its quality and quantity.
 
Human race of this century will be the first group of people to jointly witness the meaning of the word “Longevity”.  When society construction is moving forward to an elderly’s era, human can rely on good medication technology and medical services to maintain his life, gracefully with fine quality of life.  Which eventually increase our reliance on Medical services, as well as the expectation and inquiry of service standard. .  
 
Since March 1995, Taiwan government commenced to implement health care insurance plan for all citizens, it actually decreased people’s medical inquiry’s economic barrier, also triggered the general public to have a better expected standard on medial service’s standard and competition among all in Medical industry.
 
Since Medication Service Industry(MSI) differs to traditional service industry on service designation and service professionalism, traditional production industry’s marketing bible -- 4P, Product, Price, Promotion and Place are not enough for MSI.  MSI marketing strategy also requires 3 more Ps (Booms & Bitner 1981), they are Participants, Physical evidence and Process of service assembly.  Agree by service providers or by service receivers , service industry will emphasizes on service’s process.  Not just on tangible issues. 

In traditional service industry, consumer and patient are more or less able to support and to get useful information base on his own experience.   But, this experience does not apply to Medication service industry.  Because medication service providers generally are more professionalism oriented, they decide the service quality and quantity base on their professional training, therefore, consumers, or, patients has a very limit space to negotiate service issues with providers.  Basically, medication service industry may be called a Professional Fascist.  However, due to popularity of active consumer concept and easy to have medication knowledge. Consumers or patients are more possible to participate on establishing and implementation of medical treatment.

Although there are more and more scholars commence to study on service industry, mostly, they concentrate on service quality on procurement process, and less focus on industries require service provider and consumer to have more frequent interactive in between, i.e. Medical treatment industry.   As matter of fact, whilst patients receive product or service, at the same time, they also wish to receive a more valuable experience.  However, there are very few studies of communication between medical service providers and receivers.  What we may find are more focusing on stress and adjust process when facing family member meets severe and critical health situation, and how to satisfy patient’s acknowledgement, emotional and social needs, as well as how to help patient’s family to solve anxiety and stress problems.  The purpose of this research is pushing medical hospitals or venues to build up a one on one relationship with its patients, and utilizing a more suitable method to treat patients, particularly in the dramatic changing environment as now is. Not only this movement may maintain their exists customers, also may earn new customers.  Meantime, can give hospital’s profit contribution, together with reaching a higher customer satisfaction.

第一章  緒論                          1
  第一節 研究背景與動機               1
  第二節 研究目的                     3
第二章  文獻探討                      5
  第一節 醫療服務與顧客滿意度         5
  第二節 顧客參與的定義               9
  第三節 顧客參與對服務品質的影響    16
  第四節 研究架構                    19
第三章	研究設計與方法              20
  第一節 研究方法之選擇              20
    一、	質性研究：                  20
    二、	深度訪談法：                21
  第二節 研究對象                    23
第四章  實證結果分析                 25
  第一節 醫病溝通的現象              25
    一、看診的時間有限               25
    二、專業知識的不對稱             27
    三、顧客的情緒問題               29
    四、觀念及價值觀的不同           30
  第二節 顧客參與的情境分析          32
    一、顧客個性與背景對於參與的影響 32
    二、不同疾病類型顧客參與的程度   32
    三、第三者參與對醫療溝通的影響   34
  第三節 顧客參與對醫療服務的影響    36
  第四節 醫師對顧客參與的因應方式    40
第五章  結論與建議                   43
  第一節 研究結論                    43
    一、醫師與顧客間的溝通問題       43
    二、第三者對醫療溝通的影響       44
    三、顧客參與對醫療服務的影響     45
    四、醫師對顧客參與的因應方式     46
  第二節 研究建議                    48
  第三節 研究限制                    50
參考文獻                             51
 一、中文部分:                       51
 二、英文部分:                       52
附錄  訪談問題大綱                   57

表目錄
表2-2-1顧客參與之相關性文獻整理	12
表2-2-2醫療行為中顧客參與程度	14
表3-2-1醫師受訪者的基本資料	23
表3-2-2病患受訪者的基本資料	24
表4-3-1病患參與對醫師的正面影響	36
表4-3-2病患參與對醫師的負面影響表	37
表5-1-1醫師與顧客間的溝通問題	43
表5-1-2高度顧客參與的因素:	         44
表5-1-3第三者對醫療溝通的影響	44
表5-1-4顧客參與對醫療服務的正面影響	45
表5-1-5顧客參與對醫療服務的負面影響	46
表5-1-6顧客參與的處理方式	         46

一、中文部分:
1. 王俊文、葉德豐、陳紫郎(1999)，健保新時代醫療產業之生態與因應，醫院雜誌。
2. 台灣地區醫院數(2004)，行政院衛生署。
3. 宋瑞樓(2000)，台灣之醫療品質及其影響因素之言議，台灣醫界。
4. 李河蒼(1994)，主觀交易成本與水平整合組織選擇─以牙醫診所營業規模為實證對象，清華大學經濟學研究所碩士論文。
5. 林永福(2002)，公立醫院以行銷管理突破經營瓶頸之探討，政治大學經營管理碩士論文。
6. 吳孟芬(1997)，服務情境中之溝通問題分析:以醫療服務為例，中正大學企業管理研究所碩士論文。
7. 陳拱北預防醫學基金會(1997)，公共衛生學，巨流圖書公司。
8. 陳楚杰(1992)，醫院組織管理，宏翰文化事業有限公司。
9. 陳楚杰(1996)，醫院資材管理系統之研究，中國醫藥學院醫務管理研究所碩士論文。
10. 孫安華(2002)，醫院採用顧客關係管理之研究，成功大學企業管理所碩士論文。
11. 曹瓊文(2000)，專業服務接觸、實體環境線索、性別刻板印象與顧客反應關係之研究-以牙科醫病互動性服務為例，成功大學國際企業研究所碩士論文。
12. 楊錦洲(1997)，服務業品質管理，品質學會。
13. 張正二(1991)，醫院策略規劃，醫院雜誌。
14. 張永裕(1986)，醫院管理的行銷觀念，醫院雜誌。
15. 張哲碩(2002)，顧客滿意與員工滿意之衝突與解決之道--以旅館業為例，中正大學企業管理研究所碩士論文。
16. 梁禮卉(2004)，美髮服務業中顧客參與之前因與結果探討，銘傳大學管理科學研究所碩士論文。
17. 黃秀雅(2000)，醫病溝通中第三者角色、影響與因應之分析，中正大學企業管理研究所碩士論文。
18. 黃瑞美、錢端蘭（1997），“急診室病患家屬與護理人員對自覺需求認知之探討”， 榮總護理期刊。
19. 劉平文(1993)，經營分析與企業診斷，華泰書局。
20. 劉盈君、王桂芸、馬鳳岐（1999），加護病房病人家屬與護理人員對感受家屬需求差異之比較，公共衛生雜誌。
21. 蔡哲宏(1996)，急診病人選擇醫院之考慮因素探討及行銷研究—以台北市八家醫院為研究，國立陽明大學醫務管理研究所碩士論文。
22. 謝啟瑞(1997)，健康經濟學，五南圖書出版公司
23. 蕭淑貞、李明濱（1998），健康體系溝通理論與技巧，醫學人文叢書5，台灣大學醫學院
二、英文部分:
1. Andreassen, T. W. & Lanseng, E., (1997),”The Principal’s and Agents’ Contribution to Customer Loyalty within an Integrated Service Distribution Channel-An External perspective,” European Journal of Marketing, Vol. 31, No.7, pp.487-503, 
2. Andressen T. W. & Lindestad, B.,(1998),” Customer Loyalty and Complex Services-The Impact of Corporate Image on Quality, Customer Satisfaction and Loyalty for Customers with Varying Degrees of Service Expertise,” International Journal of Service Industry Management, Vol. 9, No.1, pp.7-23
3. Bateson, J.G., (1985), “Self-Service Consumer: An Exploratory Study,” Journal of Retailing, Vol. 61, No.3, pp.49-76
4. Bendapudi, N. and Leone, R. P.,(2003), “Psychological Implications of Customer Participation in Co-Production,” Journal of Marketing, Vol. 67, No. 1, pp. 14-28
5. Bensing, J. M. (1991), “Doctor-Patient Communication and the Quality of Care,” Social Science and Medicine, 32, pp.1301
6. Bettencount, L. A.,(1997), “Customer Voluntary Performance: Customers as Partners in Service Delivery,” Journal of Retailing, Vol. 73, No.3, pp.383-406
7. Bitner, M. J., Faranda, W. T., Hubbert, A. R., and Zeithaml, V. A., (1997), “Customer Contributions and Roles in Service Delivery”, International Journal of Service Industry Management, Vol. 8, No. 3, pp. 193-205
8. Bloemer, J. ,Ruyter, K. D. & Peeters, P.,(1998) Investigating Drivers of Bank Loyalty: the Complex Relationship between Image, Service quality and Satisfaction. International Journal of Bank Marketing, Vol.16, No. 7, pp.276-286
9. Booms, B., Bernard, H., Bitner M. J.(1981), “Marketing Strategies and Organizational Structure for Service Firms,” Marketing of Service, American Marketing Association
10. Bowen, D. E., and Schneider, B., (1985), “Boundary-Spanning Role Employees and the Service Encounter: Some Guidelines for Management and Research,” The Service Encounter, Lexington Books, MA: Kexington, pp. 127-148 
11. Brantes, F. S., and Galvin R. S.(2001), “Creating Connecting and Supporting Active Consumers,” International Journal of Medical Marketing, Vol. 2, pp.73-80
12. Buller, M. K. and Buller, D. B. (1987), “Physicians’ Communication Style and Patient Satisfaction,” Journal of Healthy Social Behavior, Vol. 28, pp.375
13. Castejon, J. (1993), “Cancer Patients: Health Information and Quality of Life. The 7th Conference of the European Health Psychology,” Society Abstract
14. Cermak, D. S. P., File, K. M., Prince, R. A., (1994), “Customer Participation in Service Specification and Delivery,” Journal of Applied Business Research, Vol. 10, Issue 2. pp.90-98
15. Ennew, C. T., Binks, M. R., (1999), “Impact of Participative Service Relationships of Quality, Satisfaction and Retention; An Exploratory Study,” Journal of Business Research, Vol. 46, pp.121-32
16. Firat, A. F., Dholakia, N. and Venkatesh, A.,(1995), “Marketing in a Postmodern World,” European Journal of Marketing, Vol. 29, No. 1,  pp. 40-56
17. Heiens RA. ＆ Pleshko LP.（1997） A Preliminary Examination of Patient Loyalty: An Application of the Customer Loyalty Classification Framework in the Health Care Industry. Journal of Hospital Marketing, Vol.11, No2, pp105-14.
18. Hubbert, A. R., (1995), “Customer Co-creation of Service Outcomes: Effects of Locus of Causality Attributions,” unpublished doctoral dissertation, Arizona State University
19. Kellogg, D. L., Youngdahl, W. E. and Bowen, D. E., “On the Relationship Between Customer Participation and Satisfaction: Two Frameworks,” International Journal of Service Industry Management, Vol. 8, No. 3, 1997, pp. 206-219
20. Kelley, S. W., Hoffman, K. D. and Davis M. A. (1993), “A Typology of Retail Failures and Recoveries,” Journal of Retailing, Vol. 69, No.4, pp. 429-52
21. Kelley, S. W., Donnelly, J. H., and Skinner, S. J., (1990), “Customer Participation in Service Production and Delivery,” Journal of Retailing, Vol. 66, No. 3, pp. 315-35
22. Kurtz, D. L., and Clow, K. E., (1998), “Service Marketing,” Joen Wiley & Sons, Inc.
23. Larsen, K. M. and Smith, C. K. (1981), “Assessment of Nonverbal Communication in the Patient-Physician Interview,” Journal of Family Practice, Vol.12, pp.481
24. Leinonen, T., Leino-Kilpi, H., Stahlberg, M-R, Lertola, K., (2001), “The Quality of Preoperative Care: Development of a Tool for the Perceptions of Patients,” Journal of Advanced Nursing, Vol. 35, No.2, pp 294-306
25. Lengnick-Hall, C. A.,(1996) “Customer Contributions to Quality: A Different View of the Customer-Oriented Firm,” Academy of Management Review, Vol. 21, No. 3, pp. 791-824
26. Levinson M., (2002), “Getting to Know You,” CIO, Framingham, 15:76-82 
27. Lovelock, C. H.,(1983), “Classifying Services to Gain Strategic Marketing Insights,” Journal of Marketing, 47:9-20
28. Mill, P. K., and Moberg, D. J, (1982), “Perspectives on the Technology of Service Organizations,” Academy of Management Review, Vol. 7, pp.467-78
29. O, Connor, S. J. , Shewchuk, R. M. & Bowers, M. R.(1991). A Model of service Quality Perceptions and Health Care Consumer Behavior. Journal of Hospital Marketing, Vol.6, No. 1, pp.69-92
30. Olivea, T. A., Oliver, R. L., & MacMillan, L. C. (1992), “A Catastrophe Model for Developing Service Satisfaction Strategies,” Journal of Marketing, Vol. 56, No. 7, 83-95.
31. Parasuraman, A., Zeithaml, V. A., and Berry L. L., (1985), “A Conceptual Model of Service Quality and Its Implications for Future Research,” Journal of Marketing, Vol. 49, pp. 41-50
32. Raaij. W. V. and Pruyn, T. H. (1998), “Customer Control and Evaluation of Service Validity and Reliability,” Psychology & Marketing, Vol. 15, pp.811-32
33. Rodi, A. R. and Kleine, S. S. (2000), “Customer Participation in Service Production and Delivery,” Handbook of Services Marketing and Management, California: Sage Publications, Inc., pp. 111-26
34. Roter, D. L. and J. A. Hall and N. R. Katz (1987), “Relations between Physicians’ Behaviors and Analogue Patients; Satisfaction, Recall, and Impression,” Medicine Care, Vol. 25, 437
35. Smith, C. K., E. Polis and R. R. Hadac (1981), “Characteristics of the Initial Medical Interview Associated with Patient Satisfaction and Understanding,” Journal of Family Practice, Vol. 12, 283
36. Waitzkin, H. (1984), “Doctor-Patient Communication. Clinical Implications of Social Scientific Research,” Journal of American Medical Association, 252, 2441