診療費の情報提供と病院の満足度に関する調査

わが国での医療の質の向上に対する取り組みは,病院機能評価や様々な満足度調査,医療の情報開示をはじめとして盛んに行われてきているが,診療情報の開示と病院の満足度の関連についての研究はない.本研究では,診療録開示の中でも特に診療費に焦点を当て,診療報酬明細書開示や診療費の情報提供に対する患者の意識と患者満足度の関連を明らかにし,今後の患者への情報提供について検討するものである.本研究は,調査対象施設に来院した外来患者とその付き添いの者に対し,診療費に関する意識・医療費の情報提供・患者満足度に関する自記式質問紙調査を行った.得られた回答より,559名を有効回答とし,診療費に関する情報提供の意識と満足度の関連を分析した.その結果,下記のような結果が得られた.1)病院全体への満足度に最も寄与したのは,「医師の説明」と「看護師の技術と能力」と「院内の待ち時間」であった.2)65%の患者が詳細な明細書を必要とし,その理由は診療内容を知る目的であった.3)詳細な明細書の要望は病院全体への満足度に関連していた.今後,明細書に記載される内容として,レセプト開示が患者の求めている情報になるかを明らかにする必要がある.

Approaches to improve the quality of medical service have been studied in Japan by investigating patient satisfaction, the disclosure of their medical records and others. On the other hand, there have been no research studies on the relationship between patient satisfaction and the disclosure of the details of payment for medical services. In this study, we focused especially on medical expenses and investigated whether the disclosure of the details of payment contributed to patient satisfaction. We carried out a questionnaire to be filled out of out-patients and their attendants on patient satisfaction and the disclosure of the details of payment, and obtained 559 valid replies. The results of the statistical analysis were as follows: 1)The factors that contributed most to patient satisfaction were physicians' explanations, the skill and the competency of nurses, and waiting time. 2)65% of patients requested a detailed receipt, the main reason being to know the details of medical treatment. 3)The request for a detailed receipt (a break-down of payment for medical services) was also associated with satisfaction with the hospital as a whole. These results revealed the possibility that disclosing the details of payment for medical services could contribute to patient satisfaction. They also suggested the necessity of further studies on medical record disclosure and the actual informational needs of patients.