全民健保的組織社會學

Organizational Perspective of National Health Insurance

今日的全民健保面對一個大家都知道的死結：醫療資源投入不足與對「增加投入能否買到等值的服務內容」信心不足。這是2002 年台灣醫療改革基金會，提出「先補破口袋，再掏民眾錢」的理由。於本文，我從認識和正視當代社會新人種，法人組織，的角度切入，主張醫政必須在組織治理上補強，以帶出全民健保的永續經營。本文列舉過去十多年醫改會之倡導議題，以說明醫改會的所做所為，無非是要求醫療照護產業的經營者依循醫療專業和公司治理行事。醫政主管的職責就是嚴格把守醫療專業和職業安全的底線，為全民購買的醫療品質把關。衷心期待因著醫政主管的盡職努力，醫改會不再有倡導空間。

Taiwan national health insurance has been facing a deadlock of insufficient investment on medical care sector and lack of confidence on money value with respect to the quality of medical care for many years. Accordingly, Taiwan Healthcare Reform Foundation (THRF hereafter) in 2002 advocated to fix the waning and leaking-out bag before turning to the public for further input. In light of insightful observation by late professor J. S. Coleman on the social structure of modern society, this paper places the governance of the medical care delivery system to the center for the sustainability of the national health insurance. Current medical care delivery system consists of various corporate actors who in essence are different from the natural person. The behavior of corporate actors, as a new form of actors in modern societies, is more consequential than that of natural person to the delivery of quality medical care in cost effective format. This paper presents a case which demonstrates the effectiveness of forming a NGO/NPO to advocate patients' right during the era of organized medical care delivery. The THRF rose in 2001 to challenge the governmental offices for undutiful dealing with the substandard medical practice of the hospitals and clinics. The THRF organizes patients' voice in order to achieve effective dialogues with the governments and medical care delivery institutions.