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題名：藥商、醫院與醫師的處方決策：醫療制度與組織面之脈絡分析
書刊名：臺灣社會學刊
作者：謝幸燕
作者(外文)：Hsieh, Hsing-yen
出版日期：2005
卷期：34
頁次：頁59-114
主題關鍵詞：處方決策；代理理論；專業規範；製藥業；組織規模；Prescription decisions；Agency theory；Professional norms；Pharmaceutcal industry；Organizational size
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(4) 博士論文(2) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:3
  • 共同引用共同引用:5
  • 點閱點閱:113
本文分析台灣醫師處方決策的制度與組織的脈絡，探討藥商與醫院的管理暨採購制度對台灣醫師處方決策構成的限制與誘因。有許多因素會影響醫師的處方決策，本文的分析焦點是兩個與藥商有關的脈絡：醫院採購系統與藥商介入藥品採購的方式對處方決策權的影響；藥商按醫療機構的特性對醫師採取差別化的關係建立策略，讓不同機構層級的醫師在進行決策時面對不同的參考架構。在醫療機構管理權上升的趨勢下，醫師間需協商使用藥品的品項，並接受院方的監督。藥商會針對醫療機構規模的差異，對醫師採取不同的關係策略。在大型醫院中，藥商通常會藉提供資訊、研究經費、無酬勞動力等方式影響醫師的處方用藥。在較小的醫院與診所中，交易主要是透過市場進行，藥商藉財務誘因影響醫師的處方決定。總結來說，台灣醫師的處方決策不必然以專業知識做為參考基準。台灣的醫療體系和醫管制度容許甚至鼓勵藥商在各級醫院中使用非專業的促銷手法；藥商得提供醫師許多滿足自利動機的選擇。政府推行各項政策以提高醫師專業知識、提升醫療品質的同時，也應留意這些政策在執行上是否過度依賴量化指標，反而擴大了藥商促銷活動的影響範圍，讓醫師面臨更多非專業誘因，對醫師的處方品質產生負面的影響。
The author investigates the prescription decision-making processes of Taiwanese doctors within the context of the organizational dynamics of hospitals. As hospitals become more aware of their managerial power, the influence of doctors to make specific prescription decisions is being limited in terms of restricting categories and stocking/auditing pharmacy items. At the same time, pharmaceutical companies are using diverse strategies to influence physician choices, offering substantial incentives to large hospitals that provide greater profit compared to small hospitals and local clinics. According to the new Taiwanese model, doctors' prescription decisions are not always based on professional standards but on organizational factors. The medical system allows pharmaceutical companies to fulfill the self-interests of doctors via a combination of professional and non-professional marketing tactics, putting prescription quality in doubt.
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學位論文
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2.謝幸燕(1999)。藥品生產的制度化-制度,組織生態與消費慣行的互動(博士論文)。國立臺灣大學。new window  延伸查詢new window
3.黃肇明(1993)。醫師處方行為之研究--臺北地區八家公私立醫學中心及區域醫院之高血壓處方型態分析(碩士論文)。國防醫學院。  延伸查詢new window
4.侯海珠(2002)。高雄榮民總醫院醫師資訊需求與資訊尋求行為之探討(碩士論文)。國立中興大學。  延伸查詢new window
5.鄭淑妃(2004)。門診糖尿病合併高血壓病患藥物治療型態之研究：以某醫學中心為例，臺中。  延伸查詢new window
6.黃崇惠(1999)。全民健康保險特約診所負責醫師對廢除門診簡表制度擬採行措施研究，臺北市。  延伸查詢new window
7.吳惠美(2003)。高雄市立醫院抗生素處方之比較研究：以門診上呼吸道感染患者為例，高雄。  延伸查詢new window
8.賀家光(2003)。醫師處方藥品之關鍵決定因素：以高血壓藥為例，臺北。  延伸查詢new window
9.張依同(2000)。全民健保特約醫事機構住院病患抗微生物製劑處方型態分析，臺北。  延伸查詢new window
10.陳俞潓(1999)。臺北地區醫學中心醫師對藥品核准標示外使用的認知、態度與使用概況，臺北。  延伸查詢new window
11.王玉皎(2000)。中老年高血壓疾病之門診處方型態：健保資料庫分析，以臺北市為例，0。  延伸查詢new window
12.姚淑惠(1998)。健保特約醫事服務機構抗生素處方型態之探討，臺南。  延伸查詢new window
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17.郭正睿(2002)。中區醫學中心門診上呼吸道疾病患者之抗生素處方型態及利用分析，高雄。  延伸查詢new window
18.盧彥樺(2002)。探討DRG90之住院處方型態：以某醫學中心為例，臺北市。  延伸查詢new window
19.鄭文欽(2002)。醫院乙醯氨酚使用之費用分析：以高屏區域級以上醫院為例，高雄。  延伸查詢new window
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圖書
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