NGHIEN CVV & TRAO D O I
yv'' > v ' f
CAC YEU TO TAC DONG DEN Sif HAI LONG CUA BENH NHAN NGOAI TRU
TAI CAC BENH VIEN DA KHOA TP. HO C H I MINH
I S . PHAM XUAN LAN* & PHUNG THI HONG THAM"
Nghien cifu ndy nhdm xdc dinh cdc yeu td tdc dgng de'n sif hdi long cua benh nhdn ngoai trii tai TP.HCM. Mo hinh nghien cifu vd thang do hinh thdnh difa tren ly thuye't, ket qud cua cdc cong trinh nghien cifu vd phong vdn sdu 10 b$nh nhdn. Mgt bdng cdu hoi nhdp dUdc thiet ke de phong vdn thii 100 b^nh nhdn, tU do diiu chinh cdc thdnh phdn ciia moi thang do. Nghien cifu dd phdt trien dUdc 36 thdnh phdn chinh thtic de do ludng tdm ye'u td: cd sd vdt chdt vd moi trUdng benh vien, ndng life tdc nghiep eda bdc si vd dieu dUdng, sU quan tdm phuc vu eda benh vien, sif tin cay eda benh nhdn, ket qud khdm chUa benh, thdi gian khdm chUa benh, chi phi kham chUa benh vd sif hdi long eda benh nhdn. Tuy thugc sd hUu cong hay tU, phUcfng thUc chi trd md sd lUgng vd mUc do tdc dgng cua tUng yeu td vdo sif hdi long eda b^nh nhdn Id khdc nhau. Mgt cdch tong qudt, ndm yeu td tdc dgng den sU hdi long eda benh nhdn ngoai tru tai cdc benh vien da khoa TP.HCM la: (1) Cd sd hg. tdng vd moi trUdng eda benh vien, (2) ndng life tdc nghiep eda bdc si vd dieu dUdng, (3) sif quan tdm phuc vu eda b$nh vi^n, (4) ke't qud khdm chUa benh, (5) thdi gian khdm chUa benh.
1. GStfi thi^u
Mdi trfldng boat dgng cua benh vien trong nhflng ndm g i n day da cd nhieu thay ddi, the hien qua viec thflc thi chinh sach xa hgi hda y te; he tho'ng benh vien tfl da ra ddi va ngdy cang phat trien, ddng thdi benh vien cong dflgc lien doanh vdi cac don vi tfl n h a n de td chflc khoa khdm chfla benh theo yeu clu va khoa dieu tri ky thuat cao.
Ben canh dd, benh vien tfl cung dflgc kham bao hiem y te, dieu nay da md rdng quyen Ifla chgn cua ngfldi tham gia bao hiem y te. Ngoai ra, cam ke't cua VN khi gia nhap WTO da tao co hgi cho nudc ngoai diu tfl vao linh vflc benh vien. Ba sfl thay ddi tren da lam da dang loai hinh cham sdc sflc khde, lam tang so' Iflgng benh vien, ddng thdi tao thuan lgi cho ngfldi dan tiep can dich vu cham
sdc sflc khde. Dieu nay d i n de'n sfl canh tranh gifla cac nha cung cap dich vu, dac biet kham chfla benh ngoai tru. Sfl canh tranh chii ye'u tren ddi tflgng tfl chi tra vien phi, va xu hfldng ngay cang canh tranh t r e n nhieu dd^i tflgng benh nhan khac nhau, ke ca benh n h a n bao hiem y te. Tuy nhien, he thd^ng benh vien van cdn tdn tai mgt sd van de. Cdn nhieu y kieiTtlian phien ve thai do phuc vu cua n h a n vien y te benh vien cong, trong khi vdi cd che' tfl chu tai chinh, benh nhan ngdy cang ddng vai trd quye't dinh do'i vdi ngudn thu cua benh vien. Vd cd mgt nghich ly: trong khi benh vien cdng qua tai thi cong sua't he thdng benh vien tfl ndi chung va mgt sd khoa kham chfla benh theo yeu cau tai benh vien cdng v i n cdn tha'p. Dd'i dien vdi ap Iflc canh tranh, ve phflong dien khach
Phat trien kinh te - Thang Ba nam 2011
* TnJdng Dai hgc Kinh te TP.HCM
" Trddng Dai hot
NGHIEN CIJ'U & TRAO D O I
hang, cac benh vien ngay nay phai lam hai Idng benh nhan hon de xay dflng mdi quan he ben vflng vdi cgng ddng, viec iam nay vfla mang y ngbia nhan van vfla mang Iai Igi ich cho benh vien. Lam the nao de benh nhdn ngay cang hai long hon do'i vdi benh vien? Van de nay la mgt thach thflc do'i vdi cac nha quan tri benh vien. Hau nhfl cac nha quan tri chu yeu dfla tren kinh nghiem de ra cac quyet dinh nham nang cao mflc do hai long cua benh nhan, va cac quye't dinh nhfl vay ludn cd nhflng ban che; do dd cac nha quan tri nen cd sfl tie'p can toan dien hdn bang mo hinh sfl hai Idng cua benh nhan va cac thang do Ifldng thich hgp.
2. Ctf sdl^ thuyet
2.1 Sif hdi long cua khdeh hdng
Oliver (1981) dinh nghia sfl hai long la ket qua tfl trang thai tam Iy tdng hda cam xuc, phan anh sfl mong ddi dfldc thda man qua qua trinh t r a i nghiem tieu dung ma khach hang cam nhan dflgc.
Nhfl vay, Oliver da de cap den ba yeu to' co ban trong qud trinh hinh t h a n h sfl hai long: sfl mong dgi, cam xuc cua khach hang, t r a i nghiem tieu dung. Cam xuc cua khdeh hang thi cd tinh nhat thdi trong khi trai nghiem cua hg qua tflng dich vu thi can mgt thdi gian n h a t dinh, va dan dan khach h l n g nhan thflc rd hon ve dich vu. Ca ba yeu td deu lien quan den ca'u true va each thflc de do Ifldng sfl hai long cua cac nha nghien cflu sau nay.
Trong nghien cflu cha't Ifldng dich vu, Parasur- aman & ctg (1985, 1988) da do Ifldng mflc do hai long cua khach hang, nhflng cac tien to' cua sfl hai long chfla dflgc neu ro. Teas (1993) dfla tren cac khai niem da de xuat sfl hai long la mgt ham cua chat Iflgng dich vu, xuat phat tfl sfl cam nhan cua khach hang tren mgt giao dich cu the. Tren co sd nay, Parasuraman & ctg (1994) da phat trien hai clu true cua sfl hai Idng: trong mgt giao dich cu the va trong toan bg cdc giao dich. Sfl hai long trong mgt giao dich cu the cd nghia la sfl bai long
"ff day va bay gid" (Gronroos, 1998), trong khi sfl hai long toan bg cd dflgc tfl sfl tich luy cua tflng giao dich qua thdi gian. Dabholkar (1995) da tim tha'y: Sfl hai long va chat Iflgng dich vu la hai ca'u true phan biet trong thdi gian n g l n , tuy nhien bai ye'u td nay cd sfl hgi tu khi khach hang sfl dung
dich vu trong thdi gian dai. Parasuraman & ctg (1994) da dfla vao mo hinh hai yeu td' nfla: cha't Ifldng san pham va gia ca. Ngoai ba ye'u to' neu tren, cd hai ye'u to' khac cung tac dgng de'n sfl hai long: yeu to' tinh hud'ng va ye'u to' ca nhan (Zei- thaml & ctg, 1996, 2000). Md hinh sfl hai Idng (Parasuraman & ctg, 1994; Zeithaml & ctg, 1996, 2000) da difgc kiem dinh tinh phu hgp trong dich vu bao tri 6 to Lien Ti Bei (2001), dich vu nha bang (Andaleeb & ctg, 2006), dich vu cham sdc sflc khde (Andaleeb & ctg, 2007), dich vu hang khdng (Clemes & ctg, 2008; Mohamad Rizan, 2010).
Mo hinh si/ hai long trong giao dich cu the (transaction-specific satisfaction)
Danh gia chat Ifldng dich vu (SQ) Danh gia chat lu'dng
san pham (PQ)
Danh gia gia ca (P)
Su hai long trong giao dich cu the
Ngudn: Parasuraman & ctg (1994), Journal of Marketing, January, p.121
2.2 Sif hdi long cua benh nhdn
Donabedian (1988) cho rang muc dich cua cham sdc sflc khde khong chi n h i m cai thien tinh trang sflc khde ma cdn dap flng dfldc nhu cau va sfl mong dgi cua ngfldi benh trong qua trinh cham sdc de Iam hai Idng hg. Donabedian cho r i n g giao tiep ddng vai trd nhfl mgt cd xe chd cac thong tin cua benh n h a n de giup chan doan, lfla chgn each dieu tri ma nhd dd sfl cham sdc ky thuat dflgc t h a n h cdng. Td chflc Y te The gidi (Workbook, 2000) danh gia sfl hai Idng cua benh n h a n bao gdm: CO sd vat chat cua dich vu, sfl giup dd cua cac nhan vien hd trg, cac ngudn thdng tin, ndng Iflc cua dgi ngu nhan vien, gia dich vu, sfl phu hgp cua dich vu so vdi nhu cau cua bg, tinh s i n cd cua dich vu, thdi gian chd dgi, bieu qua cua dich vu.
Khi quan tam de'n pham vi chdm sdc, gia, mang Ifldi cham sdc thi do Ifldng mflc do hai long ciia benh n h a n dflgc xem la do Ifldng qua trinh; khi quan tam den chuyen mon giup giai quye't van de sflc khde cua benh n h a n thi do Ifldng dflgc xem la
Phat trien kinh te - Thang Ba nam 2011
^53
NGHIEN CVV & TRAO D O I
TZ^^Z/.K :>E.':.'y.-i
do Ifldng ke't qua.
Nghien cflu marketing va cac tai lieu y khoa cho t h l y cac ye'u td anh hfldng de'n sfl hai Idng cua benh nhan cung phu hgp vdi quan diem cua Para- suraman & ctg (1994) va Zeithaml & ctg (1996, 2000), cac ye'u td nay bao gdm: chat Iflgng dich vu, chi phi, ye'u td ca nhan va ye'u td tinh hud'ng, trong dd, chat Iflgng dich vu cham sdc sflc khde la yeu to' quan trgng nhat.
2.3 Dich vu khdm chUa benh tai cdc benh vi^n VN
Quy che benh vien do Bg Y te ban hdnh 1997 xac dinh cdng tac kham chfla benh la mgt trong bay nhiem vu chinh cua benh vien, bao gdm kham chfla benh ngoai tru va kham chfla benh ngi tru.
Kham chfla benh ngi tru dflgc thflc hien khi benh n h a n can nhap vien qua dem de Idm cac thu thuat, tien hanh tich cflc cac chi dinh chuyen mon, cham sdc va theo doi chat che trong mgt thdi gian nha't dinh. Kham chfla benh ngoai tru, benh nhan khong can phai nhap vien de theo ddi tai benh vien. Hai dich vu kham chfla benh ndi chung lien quan den nhieu tac nghiep, nhieu nhan vien khac nhau, nhieu cugc giao tie'p c l n thiet gifla benh nhan va thay thudc, sfl lien ket cac dfl lieu tham kham de dfla ra mgt phac dd dieu tri va theo ddi tinh trang benh phu hgp tflng ca nhan, va muc dich cudi cung la hdi phuc sflc khde cho benh nhan. Vi b i n chat la mgt dich vu, kham chfla benh cung cd nhflng dac tinh cua mgt dich vu ndi chung. Tuy nhien, dich vu kham chfla benh cd hai net ndi bat. Thfl nhat, mdi quan he gifla benh nhan va thay thudc, dac biet ve m a t truyen thd^ng thi md'i quan he nay luon dflgc chu y. Thfl hai, ket qui cua qua trinh kham chfla benh, dieu nay phu thudc nhieu ye'u to' nhfl: ban chat cua tflng Ioai benh, ky nang cua thay thudc, co sd vat chat va trang thiet bi cua benh vien, sfl hgp tac gifla benh nhan va thay thud'c, kha nang tai chinh cua benh nhan, kha nang cua n e n y hgc hien dai... Mat khac, ngoai ye'u to' tinh hud'ng nhap vien hay khdng nhap vien qua dem, dich vu ngi tru va ngoai tru cd khac nhau ve cau true dich vu, quy trinh va sfl van hanh cua dich vu, thdi gian nam vien vd cbi phi cho toan bg dich vu. Nhfl vay, ve mat Iy thuyet, kham chfla benh ngi tru hay ngoai
Phat t r i e n kinh te - T h a n g Ba n a m 2011
tru khdng khac nhau ve mo hinh sfl hai long nhflng khac nhau ve chi tiet de do Ifldng tflng ye'u td tac dgng de'n sfl hai long cua benh nhan. Tai VN, kham chfla benh ngoai trfl Id mgt cdng tac rat Idn cua cac co sd kham chfla benh (Le Nggc Trgng & ctg, 2001), thflc vay, dfla tren sd lieu kiem t r a 932 b e n h vien toan qudc cua Bg Y te nam 2008, chi cd 7,7 % benh nhan phai vao nam dieu tri ndi trfl. Tai cac benh vien da khoa, khoa kham benh ngoai tru gdm cac chuyen khoa nhfl:
ngi khoa, ngoai khoa, san khoa, nhi khoa va mpt so' chuyen khoa khac de dap ufng nhu cau kham chfla benh khac nhau cua ngfldi dan.
3. PhiMig phap nghidn cihi 3.1 Mo hinh ly thuyet
Nghien cflu Ifla chgn mo hinh Iy thuye't cua Parasuraman & ctg (1994), Zeithaml & ctg (1996, 2000) de phat trien mgt md hinh Iy thuye't ve sfl hai Idng cua benh nhan. Cac thugc tinh ve nhan khau hgc dflgc thu thap nham phac hga dac trflng cua mau nghien cflu. Mat khac, mgt chuan tinh hud'ng ap dung chung cho cac ddi tflgng ma tinh trang khdng can phai nhap vien qua dem de dieu tri, nghia la trong nghien cflu nay chi khao sat tren benh n h a n ngoai tru, va dich vu dflgc nghien cflu la dich vu kham chfla benh ngoai tru. Md hinh Iy thuyet ve sfl hai Idng cua benh nhan ngoai tru nhfl sau:
Md hinh ly thuyet ve si,/ hai long cua b$nh nhan ngoai tru
juiiniay
Sir thau cam — Phuang tien huu hinh Su dap ung Nang luc phucvu
Chat lugng . djchvu
Chi phi
— >
Su hai long cua benh nhan
ngoai trii
Hon nfla, muc tieu cua nghien cflu tap trung vao md'i lien he nhan qua gifla cac yeu to' va sfl hai long cua benh nhan, theo quan diem cua Cronin & Taylor (1992), Teas (1993) va Zeithaml
& ctg (1993), nghien cflu chi do Ifldng sfl cam nhan cua benh nhan qua mdt dgt kham chfla benh cu
NGHIEN Ctfu & TRAO D O I
OEviLOPVgM n r / g . v
the. v a dfla t r e n each thflc cua Andaleeb & ctg (2001, 2007), cac yeu to' cua cha't Iflgng tac dgng trflc tie'p de'n sfl hai long.
3.2 Cd sd phdt trien cdc thang do
Thang do cua Babakus & Mangold (1992) la sfl ke thfla cd chgn lgc cua thang do Servqual (Para- suraman & ctg, 1988) vao Iinh vflc kham chfla benh ngi tru d My. Thang do chat IflOng kham chfla benh ngoai tru tai Han Quo'c (Choi & ctg, 2002; Cho & ctg 2004) da dflgc kiem dinb do tin cay va mgt sd thang do khac dfldc tham khao de hd trg cho nghien cflu dinh tinh tai cac benh vien da khoa TP.HCM.
3.2.1 Nghien cdu dinh tinh
Qua phdng van sau 10 benh n h a n ngoai trd, hlu het benh n h a n quan tam de'n chat Ifldng kham chfla benh, cdc y kien cua benh nhan khi do'i chieu vdi cac thang do cho tha'y co nhieu diem tflong ddng va mgt so diem khac nhau, cac y kien nay dflgc xep vao nam ye'u to' cua thang do Servqual (Parasuraman & ctg, 1988). Da sd benh nhan danh gia cao vai trd bac si trong kham chfla benh ngoai tru. Nhflng benh n h a n kham tai cac benh vien cdng thi tin tfldng chuyen mdn cua nhan vien y te vd ky thuat cua benh vien, tuy nhien cd nhieu benh nhan khdng hai long ve thdi do phuc vu cua dpi ngu n h a n vien. Benh n h a n cung ludn bay td suy nghi ve tay nghe cua bac si va dieu dfldng. Cac cugc phdng van cho thay ban nang cua con ngfldi ludn mong mudn sflc khde trd lai binh thfldng nhfl luc hg chfla bi benh, dd la muc dich chinh cua benh n h a n khi den benh vien, va rat mud'n biet nhflng thdng tin ve sflc khde cua hg, chang ban nhfl ke't qui xet nghiem, bi benh gi, cd t r i m trgng hay khdng t r i m trgng, .. dieu nay phu hgp vdi quan diem cua Zeithaml (1993) trong ly thuye't ve dich vu. Bgnh n h a n rat can nhlc ve kha nang chi tra khi chgn mgt benh vien, dac biet do'i vdi benh vien tfl. Mgt Iflu y nfla, thdi gian kham benh keo dai da anh hddng tieu cUc de'n tam ly cua benh nhan, mgt so' benh nhan cho ring hg chgn benh vien tfl vi mgi viec dflgc thflc hien nhanh chdng. Ngoai ra, benh n h a n cdn than phien khoa phong chat hep, ve sinh kem, bac si va benh n h a n khdng du thdi gian de trao ddi, thieu ngfldi hfldng dan, phong lam viec khd tim
tha'y. Tfl ke't qui phdng van sau, nghien cflu ndy de xua't them ye'u to' "ke't qua kham chfla benh"
va "thdi gian k h a m chfla benh" vao md hinh nghien cflu.
Mo hinh "-uliicii cflu chinh thflc
Su tin cay Su thau cam PhuoiiK tien hiru hinh Sir dap img Nang lire phuc vu Thai gian kham chira
Ket qua kham chira benh Chi phi kham chira benh
Su hai long cua benh nhan ngoai \m
3.2.2 Cdc thang do chinh thtic
De cd cac thang do chinh thflc, mgt bang cau hdi nhap dflgc thiet ke vd tien hanh phdng van thfl 100 benh nhan ngoai trd, thang do Likert 5 diem dflgc dung de do Ifldng bien quan sat. Thdng tin thu t h a p dflgc phan tich va tdng hgp, cac thanh p h i n cua tflng thang do dflgc chinh sfla va bd sung. Cd 36 thanh phan dflgc xay dflng de do Ifldng 9 ye'u to' nhfl sau: sfl tin cay cd 4 t h a n h p h i n , sfl thau cam cd 4 thanh phan, phflong tien hflu hinh cd 6 thdnh phan, sfl dap flng cd 3 thanh p h i n , nang Iflc phuc vu cd 5 thanh p h i n , thdi gian cd 3 thanh phan, ke't qua kham chfla benh cd 4 thanh p h i n , chi phi cd 3 thanh phan, sfl hai Idng cd 4 thanh phan.
3.2.3 Thiet ke nghien ciiu dinh lugng
Phdng van trflc dien hoac tfl dien vao bang cau hdi dflgc tien h a n h tren benh nhan ngoai tru cua benh vien Nguyen Tri Phflong, benh vien Van Hanh, va Trung tam Chan doan Y khoa Medic vdi cd m l u dfl kien la 450, chgn m l u theo phflong phap phan t i n g dfla tren ty le benh nhan vd loai benh. Benh nhan m i c cac benh phd bien tai cac benh vien TP.HCM nhfl: hd bap, t u l n hoan, tieu hda, tie't nieu, t h a n kinh, co xflong khdp. Do tudi
Phat trien kinh te - T h a n g Ba nam 2011
N G H I E N Cxjfu & TRAO D O I
tfl 20 den 65 vdi dieu kien biet dgc, hieu, biet viet va benh nhan da ke't thuc it nha't mgt dgt dieu tri trong nam 2010. P h i n mem SPSS 17.0 dflgc dung de xfl ly dfl lieu, danh gia do tin cay cua thang do b i n g Cronbach's alpha. P h a n tich n h a n to' vdi phdOng phdp rut trich cac t h a n h p h i n chinh va phep xoay vuong gdc, tren co sd cac nhan td dflgc rut trich, mo hinh dflgc hieu chinh. P h a n tich tflOng quan, phan tich hdi quy va kiem dinh cac gia thiet dflgc thflc hien.
4. Ke't qua nghien cuti 4.1 Ddc tinh eda mdu
Mlu nghien cflu n = 457 benh nhan ngoai tru cua benh vien NguySn Tri Phflong, benh vien Van Hanh va Medic; ty le l l n Iflgt la 41%, 21% va 38%;
ty le cac loai benh cung g i n dung nhfl dfl kien. Cd 9% benh nhan cd hgc van ca'p 1 va 91% hgc van tfl cap 2 trd len, do tudi tfl 20 den 60 chiem 91%, can bg va cdng n h a n vien s i n xua't chie'm ty Ie cao nha't (38%). Ve mflc thu nhap, cd 69% benh nhan thu nhap tfl 2 - 6 trieu ddng, va chi cd 7%
benh nhan cd thu nhap tren 6 trieu ddng, nhfl vay mlu nay dai dien dflgc cho so' dong benh nhan ve thu nhap. Cd 42% benh n h a n b l o hiem y te vd 58% phai tfl chi tra toan bg chi phi, benh nhan bao hiem y te tai benh vien cdng chie'm 88%, benh nhan tfl chi tra toan bg chi phi tai benh vien tfl chie'm 89%.
4.2 Thang do
Khao sat tren m l u d l y du vdi n = 457, chin thang do deu cd he so' Cronbach alpha > 0,7 vd tflong quan vdi bien tong cua ta't ca cac bien quan sdt deu ldn ho'n 0,3. Ket q u i phan tich n h a n td cho mdi thang do deu co phflong sai trich > 50%.
4.3 Ket qud phdn tich nhdn td
Vdi he sd KMO = 0,912 va kiem dinh Bartlett vdi mflc y nghia < 0,001, cd 7 n h a n td dflgc rut trich vdi tdng phflong sai trich Id 68,8% va mdi nhan td deu cd gia tri Eigen > 1. Bdn nhan td v i n gifl nguyen thanh phan ban diu nhfl: phflong tien hflu hinh, ke't qui kham chfla benh, thdi gian va chi phi kham chfla benh. Sfl tin cay chi cdn ba t h a n h phan, t h a n h p b i n thfl ba da hgp vdi cac thdnh p b I n khac tao t h a n h nhan td 2. Cac tbanh p h i n cua "sd ddp flng", "sfl tha'u cam" va "nang Iflc phuc vu" da cd sfl s i p xep lai binb thanh nhan
to' 2 va n h a n to' 4.
Bang 1. Ket qua phan tich cac nhan to
Nhan t o
1 2 3 4 5 6 7 T o n g c g n g
Gia trj Eigen
11,078 2,802 2,287 1,803 1,618 1,327 1,099
P h f l d n g sai t r i c h
12,365 12,159 11,022 10,552 7,865 7,791 7,043 68,8%
Cronbach alpha
0,868 0,881 0,843 0,899 0,870 0,802 0,826
4.4 Mo hinh hieu chinh
Bien phu thudc la sfl hai long va bay bien dgc lap nhfl sau:
Bien 1: Co sd vat chat va mdi trfldng benh vien, ky hieu TAN vdi 6 t h a n h p h i n .
Bien 2: Nang Iflc tdc nghiep cua bac si va dieu dfldng, ky hieu PRO vdi 8 thanh p h i n .
Bien 3: Ke't q u i kham chfla benh, ky hieu OUT vdi 4 thdnh phan.
Bien 4: Sd quan tam phuc vu cua benh vien ddi vdi benh nhan, ky bieu CARE vdi 5 thanh phin.
Bien 5: Thdi gian danh cho mgt cugc kham chfla benh, ky hieu TIME vdi 3 thdnh phan.
Bidn 6; Sfl tin cay cua benh n h a n vao benh vien, ky hieu REL vdi 3 thanh p h i n .
Bien 7: Chi phi k h a m chfla benh, ky hieu COST vdi 3 t h a n h phan.
4.5 Gid thiet tUctng ifng vdi 7 bien dgc lap H I ; Benh n h a n cam n h a n co sd vat chat va mdi trfldng cua benh vien cang cao thi sfl hai long cua benh n h a n ve benh vien cang cao. Phat bieu tflong tfl dd'i vdi gia thiet H2, H3,H4, H6.
H5: Benh n h a n cam nhan thdi gian ddnh cho mgt cugc kham chfla benh cang lau tbi sfl hai long cua benh nhan ve benh vien cang giam. Phat bieu tflong tfl dd'i vdi g i l thiet H7.
4.6 PhUarng trinh hoi quy
Sfl bai long = a+ bl*TAN+ b2*PR0+ b3*0UT + b4*CARE -H b5*TIME + b6*REL + b7*C0ST
Trong dd: a la h l n g sd; b l , b2, b3, b4, b5, b6, b7 la cac he sd hdi quy
Phat trien kinh te - T h a n g Ba n a m 2011
NGHIEN CV\J & TRAO D O I
KOSOVK: pg.^LCg\'
4.7 Phdn tich tUcfng quan
Ngoai trfl bien chi phi, cac bien trong mo hinh deu cd tflong quan vdi nhau d mflc y nghia nhd hdn 0,05 va he sd tflong quan gifla cac bien deu
< 0,85. Cdc bien cd tflOng quan thuan chieu vdi sfl hai long bao gdm: nang Iflc tac nghiep cua bac si va dieu dfldng, sfl quan t a m phuc vu cua benh vien, ke't qua kham chfla benh, co sd vat chat va moi trfldng, sfl tin cay. Thdi gian kham chfla benh CO tflOng quan nghich chilu vdi sd bdi Idng, chi phi kham chfla benh khong cd tflong quan vdi sfl hai long cua benh nhan.
Gil thiet ve p h a n pho'i chuan cua p h i n dfl khdng bi vi pham khi thflc hien phan tich hdi quy tuyen tinh bgi, phan dfl vdi trung binh xap xi 0 va do lech chuan xap xi 1, nhfl vay, phan dfl cd phan phdi g i n nhfl phan phdi chuan.
Hien tflgng da cgng tuyen dflgc kiem tra cho tdng mo hinh vdi yeu clu VIF < 10 va cac chi so dieu kien < 30 de dam bao cac mo binh bdi quy nay khdng vi pham ve da cgng tuyen.
4.8 Cdc mo hinh hoi quy tuyen tinh
• Md hinh tdng qudt
Ve sfl hai long cua benh n h a n ngoai trd (n=457) vdi mflc y nghia cua F nhd hon 0,001 va mo hinh ndy giai thich ddgc 71,9% bien thien cua sfl hdi long la do 5 bien dgc lap.
SAT = 0,196*TAN + 0,269* PRO -i- 0,315*OUT -I- 0,178* CARE - 0,093*TIME
Ke't qui phan tich hdi quy tren m l u day du da ung hg cac gil thiet H I , H2, H3, H4, H5 va khong ung hg gia thiet H6 va H7. Trong dd, ke't qui kham chfla benh cd tac dgng manh nha't, ke de'n la nang Iflc tac nghiep cua cac bac si va dieu dfldng. Chi phi khdng cd tac dgng de'n sfl hai ldng cua benh n h a n ngoai tru. Dfl lieu tie'p tuc dflgc phan tich dfla tren loai hinh benh vien hoac phflong thflc chi tra vien phi, ke't qua cd them bdn mo hinh cd y nghia:
• Md hinh sii hdi ldng cua benh nhdn ngogi trti benh vien cdng (n=187)
Vai mdc y nghia cua F < 0,001 va md hinh ndy giai thich dflgc 74,1% bien thien cua sfl hai ldng la do 4 bien dgc lap.
SAT = 0,213 *TAN -i- 0,262*PRO -f 0,302*OUT -h 0,225*CARE
• Md hinh stX hdi long cila benh tihdn ngogi trii benh vien tu (n=270)
Vdi mflc y nghia cua F < 0,001 vd mo Mnh nay giai thich dflgc 73,6% bien thien cua sfl hai long la do 5 bien dgc lap.
SAT = 0,255*PRO + 0,387*OUT + 0,171*CARE + 0,090*REL - 0,167*TIME
• Md hinh su hdi long cua benh nhdn ngogi tni bdo hiem y te
TflOng tfl nhfl md hinh cua benh vien cdng, bdi vi dfl lieu chung cua hai mo hinh nay kha ldn (85%).
• Md hinh sif hdi long cua benh nhdn ngogi tru khdng bdo hiem y te
Tflo'ng tfl nhfl mo hinh cua benh vien tfl, bdi vi dfl lieu chung cua hai mo binh nay la 91%.
Cd ba yeu td luon ludn xua't hien trong nam md hinh la ke't qui kham chfla benh, nang Iflc tac nghiep cua bac si va dieu dfldng, sfl quan fam phuc vu cua benh vien, trong dd ke't qua kham chfla benh luon tdc dgng manh nha't, dieu nay phfl hgp vdi ke't qua cua nghien cflu dinh tinh. Mac du cd y kien than phien ve chi phi kham chfla benh cao nhflng ket qua nghien cflu dinh Iflgng cho tha'y chi phi khdng cd tdc dgng trong nam md hinh. De giai thich sfl khac biet ve cac yeu to' xua't hien trong cac md hinh, tri trung binh cua mdi yeu td dflgc xem xet, phdng van sau mgt so' benh nhan ngoai trd, quan sat lai co sd vat chat vd mdi trfldng tai ba benh vien. Nhflng n h a n dinh nhfl sau: sfl tin cay cd gia tri trung binh Idn n h a t trong cac kbai niem nghien cflu, dfla tren md hinh Kano, sfl tin cay dflgc xem la ye'u to' co ban phai cd ddi vdi dich vu khdm chfla benh, gia tang mflc do cua sfl tin cay thi khdng Iam gia tang sfl hai long, tuy nhien neu khdng cd ye'u to' ndy thi benh nhan se that vgng, nhflng do'i vdi benh vien tfl thi benh nhan cd ddi hdi k b i t khe hon, do dd sfl tin cay cd tac dgng de'n sfl hai long cua benh nhan. Benh nhan benh vien cdng cho r i n g hg v i n tin tfldng chuyen mdn cua benh vien, ddng thdi chi phi cua benh vien cdng tha'p hon so vdi benh vien td va phu hgp vdi tai chinh cua bg. Mat khac, sd qua t l i trd nen phd bien tai cac benh vien cdng, vd trong dieu kien chung nhfl the hg da va dang chip nhan sfl chd dgi. Mgt van de quan trgng nfla, co sd vat chat va mdi trfldng cua benh vien cd thflc sfl khdng anh
Phat trien kinh te - T h a n g Ba nam 2011
N G H I E N Ctfu & TRAO D O I
bfldng de'n sfl bai long cua benh nhan ngoai tru tai benh vien tfl? Thfl nha't, t r e n thflc te cd sfl khac biet nhieu ve co sd vat chat va mdi trfldng gifla hai benh vien tfl n h a n trong nghien cflu ndy, va the hien rd khi so sanh cac tri so' trung binh.
Mdi trfldng Id mgt flu the cua benh vien Van Hanh, trong khi phflong tien ky thuat la mgt flu the cua Medic. Thfl hai, moi trfldng ciia Medic chfla cai thien tflong xflng vdi nd Iflc trang bi phflong tien ky thuat tien tien. Thfl ba, trong cac thanh p h i n cua thang do "co sd vat c h i t va mdi trfldng" chi cd mgt thdnh phan de cap den phflong tien ky thuat, va dan de'n mgt h a n che khi sfl dung thang do nay ddi vdi Medic. Vdi cdc phdOng tien ky thuat vflgt trdi nhflng tri trung binh cua ye'u to ndy dd'i vdi Medic v i n tha'p hon d mdc y nghia < 0,001 so vdi benh vien Van Hanh vd sfl chenh lech nay la 0,52. Mac du thang do da dflgc kiem dinh cd do tin cay nhflng viec thiet ke thang do nay da bi ban che, thang do nay nen dflgc tie'p tuc dieu cbinh trong cac nghien cflu ve sau.
5. Nhifng ham ^ tuf ke% qua nghi§n ctfu
Nghien cflu nay giup cac nha quan tri benh vien hieu rd hon quan diem cua khach hang, ddng thdi cung cap mgt so' cdng cu de nang cao sfl hai long cua benh nhan dd'i vdi benh vien. Ket qua kham chfla benh la ye'u to' quan trgng nha't tac dgng den sfl hai long cua benh n h a n ngoai trd.
Thflc te cho tha'y khdng cd sfl khac biet nhieu ve ke't qua khdm chfla benh gifla cac khoa kham chfla benh ngoai tru trong cac benh vien da khoa cung mgt quy md hoac quy md tflong dflOng. Dflgc chfla khdi benh la mong mudn tfl ban nang cua con ngfldi va dieu ndy khdng thay ddi qua thdi gian, va cung la muc tieu cO b i n cua mdi benh vien. Do dd, nang cao ke't qua khdm chfla benh ngoai tru la mdt viec p h i i ldm nhflng chfla phai la mgt lgi the canh tranh lau dai. Ve mat chien Iflgc, benh vien cln tao ra sfl thda man mang tinh khac biet va sfl khac biet nay dflgc benh nhan va cgng ddng danh gia cao, tfl do xay dflng md'i quan he ben vflng vdi cgng ddng. C h l n g ban, "nang Iflc tac nghiep cua bac si va dieu dfldng", ye'u to' nay cd 8 t h a n h p h i n va dugc hinh t b a n h td hai nhdm:
nang Iflc chuyen mon va nang Iflc giao tie'p. Quan diem truyen tho'ng thfldng quan tam nhdm thfl nha't vd chfla quan tam dung mflc nhdm thfl bai.
Nang Iflc chuyen mon Id mdt nang Iflc mang tinh ky thuat phai cd trong khi nang Iflc giao tie'p xuat phat tfl sfl quan t a m chan tbanh cua bac si va dieu dfldng dd'i vdi benh nhan, va la ky nang mem rat quan trgng de lam t a n g sfl hai Idng cua benh nhan. Vi vay, benh vien nen cd chinh sach nhan sfl hgp ly va dam bao thflc thi chinh sach nha't quan va dung d i n . Khdng d i dang de mgt dgi ngu y bac si qua thdi gian dflgc cgng ddng cam nhan khac biet mdt cdch tich cflc so vdi mgt dgi ngu cua benh vien khac, dieu nay c l n thdi gian, chi phi, sfl ddng thuan trong td chflc va sfl quye't tam cua ban lanh dao b e n h vien. Ndi ve sfl khac biet khong cd nghia la bd qua cac yeu td khdc nhfl: co sd vat chat va mdi trfldng benh vien, sfl quan tam phuc vu cua benh vien, tiet kiem thdi gian, cac giii phap nen thflc hien ddng bg de dat dflgc cgng bfldng cao. Mgt dieu Iflu y, chi phi kham chfla benh ngoai tru khong cd tac dgng vao sfl hai long cua benh nhan; tuy nhien VN thugc nhdm nfldc co thu nhap trung binh, ngfldi dan cd the nhay cam vdi chi phi khi chgn mgt benh vien, cac nbd quan tri nen cd cbinh sach gia phfl hgp vdi khach hdng muc tieu cua benh vien.
Benh vien cdng nen khdc phuc nhflng diem ye'u giao tie'p, ddng thdi quan tam phuc vu hon nfla de nang cao sfl bai Idng cua benh nhan. Cac khoa khdm theo yeu cau tai benh vien cdng, khach hang cd nhflng nhu cau khac cln dflgc thda man, chang ban, tiet kiem thdi gian va sfl tin cay nen cai thien hon nfla. Mat khac, benh vien tfl mdi hinh t h a n h la dieu kien thuan lgi de dinh vi benh vien trong mdi trfldng cham sdc sflc khde, tfl dinh vi dd, mo hinh sfl hdi ldng cua tflng benh vien tfl cd the khac nhau. Benh vien tfl nen flng dung cong nghe thong tin de kham dung hen, dap flng nhanh chdng, hd sd an toan vd chinh xac. Sfl thiet ke phdng kham phai tdn trgng sfl rieng tfl cua benh nhan. Mdi trfldng va phflong tien ky thuat tai benh vien tfl n h a n nen dflgc dau tfl tflOng xflng, mgt tfl duy phuc vu t h u l n tuy ve chuyen mon ky thuat dang dflgc thay the bang xu hfldng cung cap nhflng dich vu chat Iflgng todn dien.
NhUng han ehe vd hUdng nghien cifu trong tUctng lai
Mau nghien cflu dflgc chgn tfl ba benh vien da khoa, do vay ke't qua cd the chfla p h i n dnh sat
Phat trien kinh te - Thang Ba nam 2011
;;i
NGHIEN CI?U & TRAO D O I
ECiy.O>-'-<: OEvtLCP^•E^^l "i
thflc nhat ve sfl hai Idng ciia benh n h a n ngoai tru tai cac benh vien da khoa TP.HCM. Hon nfla, sfl cam nhan cua benh n h a n ve chat lugng kham chfla benh ludn cd nhflng ban che. Thang do "co sd vat chat va moi trfldng benh vien" da cd nhflng ban che, nghien cflu ve sau nen tach t h a n h hai ye'u td rieng biet: (1) phflong tien ky thuat, (2) mdi trfldng cua benh vien. Mo hinh sfl hai long cua benh nhan ngoai tru thugc nhdm thu n h a p cao nen tie'p tuc nghien cflu. Tfl nghien cflu ndy cd the lam CO sd cho nghien cflu ve h a n h vi sfl dung dich vu lap lai, h a n h vi lfla chgn benh vien hoac sfl chap nhan gia trong linh vflc kham chfla benh ngoai tru. Ngoai ra, mo hinh sfl hai Idng cua benh nhan ngi tru nen dflgc nghien cflu trong tflong laia TAI LIEU THAM KHAO i
1. Andaleeb, S. et a!., (2006), "Customer satisfaction in the restaurant Industry: an examination of the transaction-specific model". Journal of Services fvlarketing. 20(1), 3 - 1 1 .
2. Andaleeb, S. et al., "Patient satisfaction with health services in Bangladesh" Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine, The Author 2007; all rights reserved.
3. Babakus, E. and Mangold, W.G. (1992),
"Adapting the SERVQUAL scale to hospital services: an empirical investigation", Health Sciences Research, Vol.26 No.2, pp.767-786
4. Choi, K.; Cho, W. ; Lee, S. : Lee, H.; Kim, C (2004),
"The relationship among guality, value, satisfaction and behavioral intention in health care provider choice: a South Korean study". Journal of Business Research;
57: 913-921.
5. Dabholkar (1995), "The convergence of customer satisfaction and service quality evaluations with increasing customer patronage". Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behavior, Vol.8, p p . 3 2 - 4 3 .
6. Oliver, R. (1981), "Measurement and Evaluation of Satisfaction Process in Retail Setting", Journal of Retailing, 57 (Fall): 25-48
7. Parasuraman, A. ; Zeithaml, V.; Berry, L. (1988)
"SERVQUAL: A Multi - Item Scale for Measuring Consumer Perception of Service Quality", Journal of Retail, Vol.64, No.1
8. Parasuraman, A. ; Zeithaml, V.; Berry, L. (1994),
" Reassessment of expetation as a comparision standard in measuring- service guality: Implication for future research". Journal of Makertlng. Vol.58 January, 1 1 1 - 1 2 4
9. Teas, R. Kenneth (1993), "Expections, Performance, Evaluation, and Consumers' Perception of Quality", Journal of Marketing, Oct. 1993; 57,4, pp.18 - 34.
10. Workbook 6 (2000), "Client Satisfaction Evaluations", WHO.
P h a t t r i e n k i n h te - T h a n g Ba n a m 2 0 1 1
