지방자치단체의 보건서비스에 대한 기대불일치가 만족 및 재이용의사에 미치는 효과 분석 = The Analysis of the Effects of Expectation-Disconfirmation Regarding Local Government Health Services on Satisfaction and Reusing Intentions

다국어 초록 (Multilingual Abstract)

The purpose of this study was to examine the effects of expectancy disconfirmation regarding local government health services on user satisfaction and intention to reuse public health centers. In the context of rapid environmental changes driven by the continuous emergence of international infectious diseases, this study sought to determine whether local public health centers contribute to improving residents’ quality of life by providing services more effectively than general medical institutions, or whether they merely fulfill minimum public health demands. Based on expectancy disconfirmation theory, a survey was conducted among individuals who had utilized public health centers in the Gyeongbuk region in 2025. Four regions—Gumi, Gyeongsan, Uiseong, and Yeongdeok—were randomly selected, and respondents were limited to patients who had visited a public health center in one of these regions within the past year. Statistical analyses were performed using IBM SPSS Statistics version 31.0. Exploratory factor analysis, validity and reliability analyses, descriptive statistics, and correlation analyses were conducted. To test the research hypotheses, multiple regression analyses were performed for satisfaction and intention to reuse. In addition, hierarchical regression analysis and the Sobel test were employed to examine mediating effects. The results of the factor analysis indicated that factors related to traditional Korean medical services were largely excluded, whereas factors associated with legally designated infectious disease management showed relatively high factor loadings. Descriptive statistics revealed that overall consumer satisfaction with medical services was generally low. however, performance related to the management of legally designated infectious diseases was evaluated relatively positively. The results of multiple regression analysis demonstrated that expectations and income level had significant effects on satisfaction. Regarding intention to reuse, expectations, satisfaction, age, income level, and frequency of visits were identified as significant influencing factors. Furthermore, the results of hierarchical regression analysis and the Sobel test confirmed that performance had a significant effect on intention to reuse through the mediation of expectancy disconfirmation, while expectations and performance exerted significant indirect effects on intention to reuse through satisfaction. These findings indicate that the mediating structure linking expectations, performance, and satisfaction to intention to reuse is statistically significant, and that the interaction among these factors plays a crucial role in shaping reuse intentions.
Finally, unlike previous studies, the findings of this study reveal that key factors related to legally designated infectious diseases exert statistically significant effects. This suggests that institutional and organizational adaptation across public health center operations is required to respond effectively to the administrative environment that has emerged in the post–COVID-19 era. Future research should employ regional comparative analyses or longitudinal research designs to more comprehensively examine changes in public health center utilization behavior.

목차 (Table of Contents)

• Ⅰ. 서 론 1
• 1. 연구의 배경 1
• 2. 연구의 목적 3
• 3. 연구방법 및 구성 4
• Ⅱ. 이론적 배경 6
• 1. 지방자치단체의 보건서비스 6
• 2. 기대불일치 11
• 3. 만족 17
• 4. 선행연구고찰 19
• Ⅲ. 연구모형 및 가설 설정 29
• 1. 연구모형 29
• 2. 연구가설의 설정 30
• 3. 변수의 조작적 정의 31
• Ⅳ. 실증적 분석 36
• 1. 자료 분석방법 36
• 2. 연구표본의 특성 36
• 3. 측정 항목의 신뢰성 및 타당성 분석 38
• 4. 가설의 검증 44
• Ⅴ. 결론 50
• 1. 연구의 요약 및 시사점 55
• 2. 연구의 한계점 및 향후 연구과제 57
• 참고문헌 58
• Abstract 64
• 설문지 66