政府推行轉診的目的,是為各醫療機構能分工合作,強化基層及家庭醫師的水準,發揮醫學中心及區域醫院教學、研究、訓練之功能,進而達到節省醫療支出,使保險單位免於虧損以及病患得到最適切醫療照顧的雙贏策略。然而,醫療保險理念與醫病之間的利益衝突,均是我們探討醫療轉診制度不能忽視之處。本文就轉診制度的特點及其運作的影響因素,根據所收集的資料,嘗試就醫師因素、制度因素、醫療結構、及民眾因素等一一加以討論。文章旨趣在於呈現轉診制度受民眾、醫療院所、甚至整個醫療體系的影響,恐怕與政府政策發揮資源善用的原意相差甚遠。建議決策單位實行長期的教育宣導,加強民眾分級醫療與雙向轉診轉檢制度之認知。同時應繼續加強對醫師、各類醫事人員及民眾之分級醫療及轉診概念的宣導。如此,長久下來才能在健保醫療費用的支付方式搭配之下,逐漸發揮政策效果。再者,就過去政策鼓勵醫學中心和民眾朝向特定的求醫行為,如今形成既得醫療優勢的組織不願盡力配合。此乃政府不願付出更高的政治代價來強制扭轉民眾求醫的習慣。所以,倘若決策場域依然處於行政部門,轉診政策大概成果有限。
The first 18-electron air-sensitive ethoxyldithiocarbonate molybdenum complex [Mo(CH_3CN)( 3- C_3H_5)(CO)_2( 2-S_2COEt)] (1) is accessible by the reaction of [Mo(CH_3CN)( 3-C_3H_5)(CO)2Br] with KS2COEt in acetonitrile. The single crystal structure of complex 1 has been determined by X-ray diffraction analysis. Crystal data for 1: space group, P21/c with a = 7.2178(1) Å, b = 12.2401(2) Å, c = 16.1978(3) Å, = 100.394(1)o, V = 1407.54(4) Å3, Z = 4. The structure was refined to R = 0.017 and Rw = 0.044. The rotational behaviors of complex 1 in solution state were detected by variable-temperature 1H NMR spectroscopy. The mechanism of rotation can be described as a trigonal twist, in which the rotation of the triangular face formed by the nitrogen ligand and the two sulfur atoms relative to the face formed by the allyl and the two carbonyl groups.