- 研究生：陳詠潔
- 論文名稱：臺灣健保自付差額特材的決策：政府、醫界、與公民團體
- 指導教授：張恒豪
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關鍵字：醫療霸權、醫療政策、去商品化
- 論文中文摘要
- 論文英文摘要
In June 2020, the National Health Insurance Administration’s announcement that “approved expenses for partial out-of-pocket payment include intraocular lens and a total of 8 categories of medical devices, and that this policy would come into effect from August 1, 2020” drew public attention. Medical professional organizations including medical groups, medical practitioners, as well as medical experts strongly opposed this move. The minister in charge of the National Health Insurance, Chen Shih Chung, invited representatives from medical professionals and citizen groups to hold a discussion on the announcement.
In the discussion session, a consensus was arrived at on three points： (1) to reconsider creating a more detailed classification of medical devices, (2) to prioritize extreme value instead of implementing the policy, and (3) to strengthen information transparency. This political decision-making process is the current study’s research object. Further, it uses the document analysis method to explore the disputes and struggles between the government, the medical professionals, as well as citizen groups in this process and presents a picture of the conflict between the health insurance system and the free market. Research data contain the minutes of the discussion session and relevant historical meetings, including their appendices.
The findings revealed that although citizen groups have the advantage of electoral mobilization, medical hegemony is stronger, thus leading policy development in favor of medical professionals’ preference. The study points out that under the free market system, although medical hegemony continues to sway the health insurance system, the inherent particularity of the latter still restricts the effect of commodification in the free market. The development of democratization in Taiwan has injected the force of laypersons into political decision-making to increase the legitimacy and stability of decision-making and at the same time reconcile political and market forces during the process. However, with information asymmetry and the political domination of medical professionals, the influence of laypersons in the decision-making process is still limited. Deep-rooted medical hegemony within decision-making organizations and processes has made the decommodification of health insurance ineffective, and the power of citizen groups is still insufficient to contend against medical hegemony.
