 |
English
|
正體中文
|
简体中文
|
全文筆數/總筆數 : 18278/19583 (93%)
造訪人次 : 914103
線上人數 : 1061
|
|
|
資料載入中.....
|
請使用永久網址來引用或連結此文件:
http://nhuir.nhu.edu.tw/handle/987654321/25964
|
| 題名: | 台灣醫療體系改革中醫病關係的變遷 |
| 其他題名: | The Transformation of Physician-Patient Relation in the Reform of Taiwanese Health Care System |
| 作者: | 張育茹
CHANG, YU-JU |
| 貢獻者: | 應用社會學系社會學碩士班
齊偉先
CHI, WEI-HSIAN |
| 關鍵詞: | 醫病關係;全民健保;新管理主義;媒體
physician-patient relationship;national health insurance;new managementism;mass media |
| 日期: | 2017 |
| 上傳時間: | 2017-12-11 14:54:23 (UTC+8) |
| 摘要: | 隨著民眾教育的水平提高、民主意識的高漲、網路的發達，醫療資訊取得變得方便，讓民眾在就醫時擁有更多發言及自主權，再加上全民健保的給付制度，造成了整個醫療管理體系往績效主義傾斜，深刻地影響了醫病關係，媒體爭競下聳動標題的使用，凸顯衝突與悲情，間接影響醫病關係的信任。本文以質性研究方式，採半結構、深度訪談、參與觀察及田野筆記收集資料，呈現第一線臨床醫護人員的真實感受及其衍生的相應對策及態度。本研究結果發現影響醫護病關係變化的三個結構性因素為，(一)在新管理主義的潮流下，健保給付制度的導致的結構性的影響，(二)基於經營需求，醫院採取績效主義及顧客管理主義，限制了醫療專業自主權，(三)資本主義社會中，消費精神影響了醫療使用者的觀念。上述的結構性因素變化，致使醫護人員臨床工作量更加重，壓縮了與病患溝通的時間。日益擴張的消費意識及醫療人權意識，日趨緊張的醫病關係，迫使醫護人員採取相對防衛性的處置與溝通。本文建議：身處醫療環節中的各個組織與成員應進行適度的自省與改善，建立透明與開誠布公的討論與溝通，相關的建制單位應建立順暢的對話管道，媒體應該傳播醫療正確、正面的訊息及內容，長遠的根本改善仍然建議醫療與社會責任教育要向下扎根。
With the increasing popularity of education, the rising of democratic consciousness, the rapid development of world internet, and the availability/accessibility of medical information, patients develop their autonomy in medical decision and health care. Under the influence of the payment system of National Health Insurance, Taiwan medical management system is dominated by performancism, which impacts on the physician-patient relationship profoundly. And the mass media tends to seek popularity by shocking statements through highlighting the conflict and tragedy of the reported events, which also indirectly affects patients' trust in their physicians. This study attempts to present the consequential affections and reactions of the front line health care professionals through the methods of qualitative research, semi-structured and in-depth interviews, observation, and field notes. The result of this research points out three structural factors which influences the physician-patient relationship: (1) the structural impact of the national health insurance system under the trend of the new managementism, (b) the hospitals' adoption of performancism and customer managementism which restricts the autonomy of medical professionalism for meeting business needs, (c) the conceptual influence of consumerism on medical consumers in the capitalist society. These aforementioned structural factors increase the medical workloads and consume time of medical personnel, leading to the lack of communication with their patients. The increasing awareness of consumerism and the human right to health, as well as the increasing tension between physicians and patients, compel the medical professionals to communicate with patients and treat diseases defensively. Therefore, this study proposes that every institution and member in the system of medical care should reflect on themselves so that they can strengthen their Weaknesses. Furthermore the mechanism of transparent and open discussion / communication should be established. The relevant departments should establish a regular dialogue channel. The media should broadcast correct and positive medical information. The basic education of medicine and social responsibility is imperative for radically resolving the proposed problems. |
| 顯示於類別: | [應用社會學系(社會工作與社會設計碩士班,教育社會學碩士班)] 博碩士論文-社會學碩士班(停招)
|
文件中的檔案:
| 檔案 |
描述 |
大小 | 格式 | 瀏覽次數 |
|---|
| 105NHU00208004-002.pdf | | 3835Kb | Adobe PDF | 1286 | 檢視/開啟 | | index.html | | 0Kb | HTML | 475 | 檢視/開啟 |
|
在NHUIR中所有的資料項目都受到原著作權保護.
|
