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題名：醫療照護系統內網路型交易與干擾影響效應 :利害關係人分析
作者：楊文惠
作者(外文)：Wen-Hui Yang
校院名稱：雲林科技大學
系所名稱：管理研究所博士班
指導教授：胡哲生
學位類別：博士
出版日期：2007
主題關鍵詞：利害關係人分析；企業網路；醫療照護系統；解離；質性研究法；Qualitative Method；Stakeholder Analysis；Health Care System；Business Network；Dissolution
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社會人口環境的變遷造成醫療照護系統內所需牽涉之相關照護機構及資源的投入益趨複雜與繁多，而全民健康保險制度的實施，則引發諸多的問題與亂象，對醫療照護系統內的各個層面皆帶來直接及重大的衝擊，其所牽涉的範圍之廣泛，所連動影響到利害關係人數量之龐大，以及成員彼此間互動關係的錯綜性，都加增了醫療照護系統的複雜性與變動性。然而，過去對於醫療照護系統現象與問題的剖析，往往是以單一成員的角度、雙邊交易的觀點來觀照和解析，已不足以真實呈現系統內利害關係人間利益錯綜的互動關係和動態過程，亦無法洞悉現象背後問題的核心與根源，致使對相關問題的釐清與解決都徒勞無功，甚至更形惡化。因此，本研究結合企業網路以及利害關係人分析的觀點，從整體性、動態性網路系統的視野，並從多元利害關係人的多面向角度，期望提出一個新的分析切入觀點，來剖析醫療照護系統內部互動關係的運作與內涵，建立切合實際且反應真相的典範基礎，以解釋和釐清醫療照護系統內部運作的真實面貌，並藉以開展未來正確的研究和分析途徑。此外，本研究亦希望藉由網路理論觀點和利害關係人觀點的引用，解析醫療照護系統與企業網路系統在應用上的差異性，發覺隱含其中的理論意義，此亦為本研究目的之ㄧ。
本研究採取質性研究的方法，以利害關係人分析法為主軸，針對醫療照護系統內與給藥服務相關的利害關係人進行深度或電話訪談，並根據紮根理論研究法的原則，以和理論相關的概念為基礎來從事抽樣，同時進行資料的蒐集和分析，直到資料�堛漕C一個範疇都達到理論性飽和為止，才結束抽樣的作業。經過上述研究歷程，本研究有下列主要研究發現：
一、醫療照護系統為一管制性的網路型交易系統，其具有多元利害關係人的組成，利害關 係人間的交易互動彼此互相關聯與傳導影響，單一利害關係人間的雙邊交易關係無法單獨存在於系統中，且系統內的交易運作均會受到第三團體的規範和影響，市場機制無法充分自主發揮。
二、利害關係人間具有形式上的共同利益訴求與實際的個別性利益訴求，其在彼此間利益干擾影響下，會無法按照原先期望的共同利益目標運作，而在態度與行為上傾向以個別性利益為主。
三、利害關係人在醫療照護系統內的不同介入與改變下，受到不同利益干擾影響效應的衝擊，其利益會在關聯互動中呈現重新分配與組合的動態。
四、醫療照護系統內利害關係人間的利益干擾或利益關聯影響性具有共同影響來源，是系統中掌握重要資源的共同第三團體，並主導整個系統的運作模式和動態。
五、利害關係人在醫療照護系統中第三團體的管制規範下，其經營運作和自主性受到衝擊和影響，會出現自外系統作為，擺脫原網路系統的管制規範和稀少資源的界限，建立新的交易關係和資源管道，自主性操作各項市場行銷機制，回復純粹雙邊交易的本質，而形成網路系統解離的現象。
本研究超越了傳統雙邊交易的思考模式，開創了以多元利害關係人多邊交易的網路系統分析典範，研究的結果與發現除了提供學術上與實務上的參考價值，以作為學術研究者在理論建構上、醫療政策制定者在政策擬定上、以及醫藥機構管理者在經營運作上之建議參考；同時據此對未來有志於醫療網路系統的研究者提出相關建議，奠定了先導性的研究基礎，以利後續醫療照護系統研究領域的拓展。
The evolution of demographic environment caused the increasingly complicated and numerous infuse of relevant health care organizations and resources involved with the health care system. In addition, the implementation of National Health Insurance also triggered various issues and chaotic situations to bring with the direct and remarkable impact on every level in the health care system. The broad ranges involved actually resulted in vast numbers of stakeholders under impacts. The said broad ranges and the complexion of mutual interaction among members both enhance the complexion and variation of the health care system. However, the past analysis on phenomenon and issues about the health care system was always observed and analyzed in view of the single perspective and dyad exchange. It was actually deficient to demonstrate the interaction and dynamic process of stakeholders'' complicated interests in the health care system and unable to insight the cores and origins behind the phenomenon. Consequently, all the delineation and solution about relevant issues were finally in vain and even worsened. Therefore, this research was implemented in view of business network and stakeholder analysis, in an version of the overall integration and dynamic network systems, together with the multiple facades in multi-stakeholders'' viewpoints. It was expected that a new analysis viewpoints could be proposed to analyze the operation and contexts of the interaction in the health care system. Consequently, the practicable paradim foundations with truth really reflected could be established to explain and delineate the true operational facades in the health care system. In addition, it was available to lead the way for correct research and analysis approaches. For another purpose of this research, we use network theory and stakeholder analysis to explore the difference between the business network system and the health care system. It aimed to delineate the theoretical implication.
This research was adopted with qualitative method and mainly axed with stakeholder analysis. The in-depth or telephone interview was implemented by focusing on stakeholders involved in the drug delivery process in the health care system. Also, based on the principles of grounded theory together with the concepts relevant to theories, the sampling is made. Meanwhile, data were gathered and analyzed and the sampling would be ended till every category with data reached theoretical saturation. After experienced with aforesaid research process, there were some findings within this research:
1.Health care system mean a type of network exchange system composed of multi -stakeholders. The exchange interaction of stakeholders interconnects mutually with impacts transferred. The dyad exchange relationship of the single stakeholders cannot exist in the system independently. All stakeholders’ operation are influenced under the control and regulation of the third-party in the health care system. They can’t operate marketing mechanism autonomously.
2.The relationship among stakeholders comes with the claim of both formal common interest and actual personal interest. Under the intervening impacts among stakeholders, it is therefore unable to operate according to the initially expected goals of common interest. The inclination of attitude and behavior trend to mainly focus on personal interest.
3.Stakeholders, under different interventions and changes in the Health Care System, are impacted by the effect caused by different intervening impacts of interest. The said interest shows the phenomenon of re-array and combination dynamics within the connected interaction.
4.The interest or impacts relevant to interest in the health care system comes with the common sources of impact. They are the third party to control important resource in the system and also dominate the operation modes and dynamics of the overall system.
5.Under the control and regulation of the third-party in the health care system, stakeholders'' operation and autonomy suffer impact and influence. There will be behaviors external to systems happening to get rid of the boundary between control regulations and trace resources of original network systems to establish new exchange relations and resource channels. Every market mechanism can be operated automatically to for the phenomenon of network system dissolution. The finding can further confirm the fact that the health care system mean a type of network exchange market under control and regulation.
This research transcended the thinking mode of traditional dyad exchange and the analysis example of network system was created in view of the multiple exchanges among multi-stakeholders. In addition to the valuable academic and practical reference, the results and findings of this research can offer the reference suggestions for theoretical establishment made by academic researchers, policies made by decision-makers of health policies and business operation made by medical organizations administrators. Meanwhile, based on aforesaid mentions, this research also proposed the relevant suggestions for researchers with concentrating effort on medical network systems in future. It was aimed to erect the preliminary foundation for researches favorably available for the research development of subsequent researchers on the health care system.
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