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題 名 | 國家與醫療專業權力:臺灣醫療保險體系費用支付制度的社會學分析=The State and Professional Power of Medicine |
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作 者 | 林國明; | 書刊名 | 臺灣社會學研究 |
卷 期 | 1 民86.12 |
頁 次 | 頁77-136 |
分類號 | 412.56 |
關鍵詞 | 國家權力; 專業權力; 民主協商制度; 醫療保險; 醫療費用支付制度; State power; Professional power; Health insurance; Payment system; Structures of democratic bargaining; |
語 文 | 中文(Chinese) |
中文摘要 | 本文考察在政府所控制的醫療保險體系中,由獨斷性的國家權力和醫師的專業權力,這兩種權力類型的交織對抗所產生的社會後果。本文的考察重點,來自於對台灣醫療保險體系中醫師種種「違反專業規範」的行為的關切。 本文的論述指出,台灣保險體系長期的問題主要來自國家權力企圖獨斷地支配醫療專業的經濟利益,但國家權力卻又無法控制醫療專業對臨床工作?容的恣意性決定能力。由於缺乏利益協商的組織空間,加上公共權威對個體行為控制的失敗,終於導致醫療專業普遍地濫用臨床權力來追求私人利益。結果,醫療專業權力的濫用,不但顛覆了國家想要控制醫療成本的目標,也腐蝕了醫療工作的倫理規範與社會關係。透過對醫療保險體系的觀察,本文從而反省了專制性的國家權力的極限性與制度的脆弱性,和對社會生活規範的破壞性後果。本文透過對醫療保險體制費用支付制度的歷史演進的觀察,檢視了國家與醫療專業的關係,從而強調建立民主化的利益協商制度的重要性,但卻留下兩個有待探索的問題。第一是民主化協商體制的運作,如何在長期受威權統治的社會成為可能。第二,由於民主化協商體制並不能自動修復已遭威權統治破壞的社會規範,環繞在醫療照護和其他社會生活領域的倫理規範和社會關係如何重建?這些未解的問題正是台灣社會所面對的嚴肅課題。 |
英文摘要 | The widespread abuse of the medical profession has plagued Taiwan's health insurance system for decades. Why has the medical profession in Taiwan been so abuse-prone? This paper examines this vexing problem from the angle of state-medical profession relations. It is argued that the chronic trouble in Taiwan's health insurance has resulted from a government-dictated payment system in which the despotic power of the state has tried to control the economic terms of medical work, but failed to monitor the behavior of physicians in their day-to-day work. Lacking collective power to protect their economic interests, doctors have wielded their professional power in determining the clinical processes to counteract the state's price controls. Consequently, the abuse of professional power has not only subverted the state's interests in cost control, but also eroded the norms surrounding the social relationships of human caring. With medical care as our empirical reference, this paper thus reflects upon the institutional vulnerability and limitations of the state's despotic power, and its destructive effects on social norms. |
本系統中英文摘要資訊取自各篇刊載內容。