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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
書刊名：臺灣社會學研究
作者：林國明 引用關係
作者(外文)：Lin, Kuo-ming
出版日期：1997
卷期：1
頁次：頁77-136
主題關鍵詞：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
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(29) 博士論文(6) 專書(1) 專書論文(5)
  • 排除自我引用排除自我引用:26
  • 共同引用共同引用:29
  • 點閱點閱:481
　　　　　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。
　　　　　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.
期刊論文
1.Wilsford, David(1995)。States Facing Interests: Struggles over Health Care Policy in Advanced, Industrial Democracies。Journal of Politics, Policy and Law，20(3)，571-613。  new window
2.Haug, Marie R.(1973)。Deprofessionalization: An Alternative Hypothesis for the Future。Sociological Review Monograph，20，195-211。  new window
3.Hafferty, F. W.、Light, D. W.(1995)。Professional dynamics and the changing nature of medical work。Journal Of Health And Social Behavior，1995(extra)，132-153。  new window
4.Field, M. G.(1988)。The Position of Soviet Physician: The Bureaucratic Professional。Milbank Quarterly，66，182-201。  new window
5.Glaser, W. A.(1994)。Doctors and Public Authorities: The Trend toward Collaboration。Journal of Health Politics, Policy and Law，19(4)，705-727。  new window
6.Haug, M. R.(1976)。The Erosion of Professional Authority: A Cross-cultural Inquiry in the Case of Physician。Milbank Quarterly，54，83-106。  new window
7.Haug, M. R.(1975)。The Deprofessionalization of Everyone?。Sociological Focus，8(3)，197-213。  new window
8.Haug, M. R.(1988)。The Re-examination of the Hypothesis of Physician Deprofessionalization。Milbank Quarterly，66(S2)，48-56。  new window
9.McKinlay, J. B.(1977)。The Business of Good Doctoring or Doctoring as Good Business: Reflections on Freidson's View of the Medical Game。International Journal of Health Service，7(30)，459。  new window
10.McKinlay, J. B.(1973)。On the Professional Regulation of Change。Sociological Review Monographs，20，61-84。  new window
11.McKinlay, J. B.、Stoeckle, J. D.(1988)。Corporation of the Social Transformation of Doctoring。International Journal of Health Services，18(2)，191-205。  new window
12.McKinlay, J. B.、Arches, J.(1985)。Toward the Proletarianization of Physicians。International Journal of Health Services，15(2)，161-195。  new window
13.張苙雲、朱永昌(19940600)。組織場域的浮現：臺灣醫療產業的研究。中央研究院民族學研究所集刊，77，157-192。  延伸查詢new window
14.張苙雲(19950100)。組織的轉型與結盟：兼論產業競爭氣候的形塑與激化。國家科學委員會研究彙刊. 人文及社會科學，5(1)，94-112。  延伸查詢new window
15.張苙雲、謝幸燕(19940200)。就醫流向的長期變遷。中華公共衛生雜誌，13(1)，54-76。new window  延伸查詢new window
16.張苙雲、謝幸燕(19940700)。醫療資源的成長與分佈--制度面成因的思考。人口學刊，16，79-106。new window  延伸查詢new window
會議論文
1.吳乃德(1989)。民主的不確定未來：解釋台灣的政治自由化現象。「中國民主的未來」研討會，時報文化基金會主辦 。  延伸查詢new window
研究報告
1.黃文鴻(1990)。全民健保藥品給付範圍及藥價基準之研究。臺北。  延伸查詢new window
2.張鴻仁(1990)。全民健保醫療費用支付制度之研究。台北。  延伸查詢new window
3.行政院衛生署(1994)。中華民國八十二年衛生統計（一）公務統計。台北：行政院衛生署。  延伸查詢new window
4.行政院主計處(1993)。中華民國台灣地區社會指標統計。台北：行政院主計處。  延伸查詢new window
5.張苙雲(19900531)。健康保險對醫療系統運作效率及績效之影響。台北。  延伸查詢new window
6.吳凱勳、李卓倫。公勞保診療費用支付制度沿革與醫療費用支出之關係。台北。  延伸查詢new window
7.李玉春(1992)。總額預算制之設計。台北。  延伸查詢new window
8.臺閩地區勞工保險局(1994)。台閩地區勞工保險統計。台北：台閩地區勞工保險局。  延伸查詢new window
9.顏淑娟(1992)。公勞保醫療費用審核制度之比較研究。台北。  延伸查詢new window
學位論文
1.林國明(1997)。From Authoritarianism to Statism: The Politics of National Health Insurance in Taiwan(博士論文)。Department of Sociology，New Haven, CT。  new window
2.陳端容(1989)。七十年代台灣醫療產業與醫療政策(碩士論文)。國立臺灣大學。  延伸查詢new window
圖書
1.Freidson, E.(1970)。Profession of Medicine: A Study in the Sociology of Applied Knowledge。New York：Harper & Row。  new window
2.Migdal, Joel S.、Shue, Vivienne、Kohli, Atul(1994)。State Power and Social Forces: Domination and Transformation in the Third World。Cambridge。  new window
3.Freidson, Eliot(1994)。Professionalism reborn: Theory, prophecy, and policy。The University of Chicago Press。  new window
4.Glaser, W. A.(1970)。Paying the doctor: systems of remuneration and their effects。Baltimore：Johns Hopkins Press。  new window
5.Stepan, Alfred C.(1978)。The State and Society: Peru in Comparative Perspective。Princeton University Press。  new window
6.Mann, Michael(1988)。States, War and Capitalism。Basil Blackwell Press。  new window
7.Glaser, William A.(1991)。Health Insurance in Practice。San Francisco：Jossey-Bass。  new window
8.Stone, D. A.(1980)。The Limits of Professional Power: National Health Care in the Federal Republic of Germany。Cnicago：The University of Chicago Press。  new window
9.行政院衛生署(1995)。全民健保實施六個月評估報吿--問題及因應措施。台北：行政院衛生署。  延伸查詢new window
10.全民健康保險規劃小組(1990)。全民健康保險制度規劃技術報告。台北：行政院經建會。  延伸查詢new window
11.立法院秘書處(1994)。法律案專輯：全民健康保險法。台北：立法院。  延伸查詢new window
12.Eckstein, H.(1960)。Pressure Group Politics: The Case of the British Medical Association。Stanford, Clif.：Stanford University Press。  new window
13.Abbot, A.(1988)。System of Professions: An Essay of the Division of Expert Labor。Chicago：University of Chicago Press。  new window
14.Field, M. G.(1967)。Soviet Socialized Medicine: An Introduction。New York：Free Press。  new window
15.Glaser, W. A.(1978)。Health Insurance Bargaining: Foreign Lessons for Americans。New York：Gardner。  new window
16.Freidson, E.(1973)。Professional Dominance: The Social Structure of Medical Care。Chicago：Aldine。  new window
17.Glaser, W. A.(1987)。Paying the Hospital。San Francisco：Jossey-Bass。  new window
18.Hafferty, F. W.、McKinlay, J. B.(1993)。The Changing Medical Profession: An International Perspective。New York：Oxford University Press。  new window
19.Haug, Marie. R.、Lavin, Bebe(1983)。Consumerism in Medicine: Challenging Physician Authority。Sage Publications。  new window
20.Mann, M.(1993)。The Source of Social Power。New York：Cambridge University Press。  new window
21.Migdal, J. S.(1988)。Strong Societies and Weak States: State-Society Relations and State Capacities in the Third World。Princeton, NJ：Princeton University Press。  new window
22.Moran, M.、Wood, B.(1993)。States, Regulation and the Medical Profession。Buckingham：Open University Press。  new window
23.Payer, L.(1988)。Medicine and Culture: Varieties of Treatment in the United States, England, West Germany and France。New York：Henry Holt and Company。  new window
24.Smith, A.(1976)。An Inquiry into the Nature and Cause of the Wealth of Nations。Chicago：The University of Chicago Press。  new window
25.Stepan, A. C.(1988)。Rethinking Military Politics: Brazil and the South Cone。Princeton, NJ：Princeton University Press。  new window
26.de Tocqueville, A.(1955)。The Old Regime and the French Revolution。New York：Doubleday。  new window
27.Wilsford, D.(1991)。Doctors and the State: The Politics of Health Care in France and the United States。Durham, North Carolina：Duke University Press。  new window
28.Ostrom, Elinor(1990)。Governing The Commons: The Evolution of Institutions for Collective Action。Cambridge University Press。  new window
29.North, Douglass C.(1981)。Structure and Change in Economic History。W. W. Norton & Company, Inc.。  new window
30.Parsons, Talcott(1951)。The Social System。Free Press。  new window
31.Tilly, Charles(1978)。From Mobilization to Revolution。Addison-Wesley。  new window
32.Putnam, Robert D.、Leonardi, Robert、Nanetti, Raffaella Y.(1993)。Making Democracy Work: Civic Traditions in Modern Italy。Princeton University Press。  new window
33.Linz, Juan José、Stepan, Alfred C.(1996)。Problems of Democratic Transition and Consolidation: Southern Europe, South America, and Post-Communist Europe。The Johns Hopkins University Press。  new window
34.North, Douglas C.(1990)。Institutions, Institutional Change And Eccnomic Performance。Cambridge：Cambridge University Press。  new window
圖書論文
1.Perrow, C.(1990)。Economic Theories of Organization。Structure of Capital: The Social Organization of the Economy。Cambridge。  new window
2.Hsiao, Hsin-huang Michael(1992)。The Labor Movement in Taiwan: A Retrospective and Prospective Look。Taiwan: Beyond the Economic Miracle。M. E. Sharpe。  new window
3.李玉春(1993)。健康保險支付制度。健康保險。台北：巨流圖書公司。new window  延伸查詢new window
4.楊志良(1992)。從全民健康保險看我國醫療保健體系。公共衛生新論。台北：巨流圖書公司。  延伸查詢new window
5.葉金川(1993)。我國健康照護體系。健康保險。台北：巨流圖書公司。  延伸查詢new window
6.Dohler, M.(1989)。Physicians' Professional Autonomy in the Welfare State: Endangered or Preserved?。Controlling Medical Professionals: The Comparative Politics of Health Governance。Newbury Park, CA：Sage Publications。  new window
7.Andersen, T.(1987)。Variations in Common Medical Practice: Some Economic Challenges。Financing and Delivering Health Care: A Comparative Analysis of OECD Countries。Paris：OECD, Working Party on Social Policy。  new window
8.Freddi, G.(1989)。Problems of Organizational Rationality in Health Controls and Policy Options。Controlling Medical Professionals: The Comparative Politics of Health Governance。Newbury Park：Sage。  new window
9.Field, M. G.(1991)。The Hybrid Profession: Soviet Medicine。Profession and the State: Expertise and Autonomy in the Soviet Union and Eastern Europe。Philadelphia：Temple University Press。  new window
10.Editors of the Yale Law Journal(1966)。The American Medical Association: Power, Purpose, and Politics in Organized Medicine。Medical Care: Readings in the Sociology of Medical Institutions。New York：John Wiley & Sons。  new window
11.Glaser, W. A.(1994)。Universal Health Insurance That Really Work: Foreign Lesson for the United States。The Politics of Health Care Reform: Lessons From the Past, Prospects For the Future。Durham, NC：Duke University Press。  new window
12.Glaser, W. A.(1986)。Payment Systems and Their Effects。Applications of Social Science to Clinical Medicine and Health Policy。New Brunswick, NJ：Rutgers University Press。  new window
13.Levi, Margaret(1990)。A Logic of Institutional Change。The Limits of Rationality。Chicago, Illinois：The University of Chicago Press。  new window
14.McKinlay, J. B.(1982)。Toward the Proletarianization of Physicians。Professionals as Workers: Mental Labor in Advanced Capitalism。Boston：G. K. Hall。  new window
15.Roemer, M. I.(1966)。On Paying the Doctor and the Implications of Different Methods。Medical Care: Readings in the Sociology of Medical Institutions。New York：John Wiley & Sons。  new window
16.Shue, V.(1994)。State Power and Social Organization in China。State Power and Social Forces: Dominination and Transformation in the Third World。New York：Cambridge University Press。  new window
 
 
 
 
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