醫藥分業政策推行對藥師專業的影響

The impacts of the implementation of the policy toward the separation of drug dispensing from medical practice on the pharmaceutical profession

謝文紘(Wen-Horng Hsieh) ； 陳美霞(Meei-Shia Chen)

《台灣公共衛生雜誌》 20卷5期 (2001/10) Pp. 395-411

https://doi.org/10.6288/TJPH2001-20-05-08

摘要

目的：本研究分析台灣醫藥分業政策內容轉變及其對藥學專業的影響。方法：我們使用三種資料來源，包括：醫藥分業政策相關之二手資料、台南縣醫藥分業社會調查、及深度訪談。結果：醫樂分業政策原先的規劃與最終實施的內容有重大轉變：(1)單軌制(診所中不聘請藥師從事調劑業務)轉變為雙軌制(診所可聘請藥師調劑)；(2)除在無藥事人員或偏遠地區外全國全面實施轉變為診所與藥局數比例達三比一地區先實施；(3)放寬醫療急迫之定義而擴展醫師調劑權的範圍。台南縣社會調查結果顯示，大多數藥師(生)(71.2%)贊成實施醫藥分業，但卻有一半以上(54.7%)的樂師(生)反對醫藥分業中雙軌制的作法，且自行開業的藥師(生)有最高的比例(67.8%)反對現行雙軌制作法。我們的深度訪談顯現，雙軌制政策的實施使大部分藥局收入降低，且對藥局經營及藥師專業有負面的影響，甚至導至「去專業化」的現象。結論：醫藥分業政策最終實施內容與原始規劃有很大的不同，這種政策轉變使得衛生署當初醫藥分業的目標－藥學專業地位的增進及社區藥局功能的健全－無法充分實現。

關鍵字

衛生政策,醫藥分業,藥局,藥學專業,專業化

並列摘要

Objectives: We analyze the changes of the policy toward the separation of drug dispensing from medical practice and their Impacts on the pharmaceutical profession. Methods: We use three Sources of data, including secondary data on the policy toward the separation of drug dispensing from medical practice, the social survey of the pharmacists and physicians in Tainan county, and in-depth interviews. Results: There are great differences between the original design and the final in-depth interviews. Results: There are great differences between the original design and the final contents of the policy toward the separation of drug dispensing from medical practice. Major changes include (l) that from a “single track” system (the clinics not allowed to dispense drugs by hiring a pharmacist) to a “double track” system (the clinics allowed to dispense drugs by hiring “a pharmacist); (2) that from the implementation of the policy in the whole nation except the rural areas without pharmacists to only in those areas with the clinics/pharmacy ratio of 3 to 1; and (3) that of expanding the scope of medical emergencies in which the physician can dispense drugs. Our survey indicates that, although majority (71.2%) of the pharmacists in Tainan county support the policy on the separation of drug dispensing from medical practice, more than half (54.7%) disagree with the “double track” system. The pharmacists who own the pharmacy in the community have the greatest proportion (67.8%) opposing the “double track” system. Our in-depth interviews indicate that the implementation of the “double track” system led to the decline of the income of the community pharmacies and had negative impacts on the management of the community pharmacies and the pharmaceutical profession as a whole, leading to the “de-professionalmunity pharmacies and the pharmaceutical profession as a whole, leading to the “de-professionalization” of the pharmaceutical profession. .Conclusions: The above policy changes result in the failure of the Ministry of Public Health to fully meet the objectives of the policy – the promotion of the status of the pharmaceutical profession and the function of the community pharmacy.

並列關鍵字

health policy,the policy on the separation of drug dispensing from medical practice,pharmacy,pharmaceutical profession,professionalization