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題名:病人安全與醫療專業變遷:批判實在論分析
作者:林昌宏
作者(外文):LIN, CHANG-HUNG
校院名稱:東海大學
系所名稱:社會學系
指導教授:許甘霖
學位類別:博士
出版日期:2022
主題關鍵詞:全民健保病人安全專業化批判實在論National Health Insurancepatient safetyprofessionalizationcritical realism
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台灣醫療場域最重要的改變,來自於 1995 年全民健康保險的施行,將全體國民納入醫療照護體系,在享受現代化醫療與完整社會保險時,也出現所謂「醫療崩壞」的指控,同時出現小型地區醫院萎縮倒閉,大型的財團連鎖醫院不斷擴增,醫療照護模式也從傳統以醫師為中心的「醫療父權」轉變為「以病人為中心」的「全人整合」模式。健保施行後的各種亂象、醫療場域組織生態的變化、以及健保支付結構問題,導致台灣醫師在專業角色以及醫病關係出現的轉變,不能僅以經濟邏輯或權力邏輯來解釋。本研究採取辯證批判實在論的 MELD 模型,指出自 2000 年開始的全球性「病人安全」議題從規範和文化認知改變了醫師專業的特質,並透過文本中介的建制化過程,讓醫療實作產生典範式的轉移。
The most important change in Taiwan's medical field came from the implementation of the National Health Insurance in 1995, which included all citizens in the health care system. When enjoying modern medical care and complete social insurance, there were also accusations of the so-called "medical disintegration". Small community type hospitals have shrunk and closed down, while large-scale consortium chain hospitals have continued to expand. The medical care model has also changed from the traditional physician-centered "medical patriarchy" to a "patient-centered" "whole person integration" model. Various chaos after the implementation of health insurance, changes in the organizational ecology of the medical field, and problems in the payment structure of health insurance have led to changes in the professional roles of Taiwanese physicians and the relationship between doctors and patients, which cannot be explained solely by economic logic or power logic. This study adopts the MELD model of dialectical critical realism, pointing out that the global "patient safety" issue since 2000 has changed the characteristics of the physician profession from normative and cultural recognition, and through the process of text-mediated institutionalization, medical practice has emerged a paradigm shift.
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