- 學位論文
住院醫師適用勞基法之政策形成過程——多元流程模式之觀點
The Policy Formation Process of Applying the Labor Standards Act to Resident Physicians:The Multiple Streams Perspective.
摘要
過去數十年來，受僱醫師的勞動權益並未獲得完善保障，醫師宛若白色巨塔裡陷在工作過勞圈套之中的隱性受害者。約於2011年以前，受僱醫師適用勞基法此議題並未獲得政府當局之關切，爾後，隨著醫師過勞與職災事件接連發生，主管機關開始設想應如何保障受僱醫師的勞動權益，並改善其過勞情況。 然而，於2011年至2018年此階段，對於受僱醫師是否適用勞基法之議題，醫院代表、相關政府部會、受僱醫師本身與利益團體等多方行動者可謂為莫衷一是，各有各較偏好的建議方案，而較難形成具體政策共識。 終於，時序發展至2018年，基於主管機關首長輪替，且各方政治能量已匯聚於本議題之上，住院醫師適用勞基法的政策窗開啟，而成為推動此政策的絕佳時機，最後主管機關決定於2019年9月1日起，僅將受僱醫師中的住院醫師此群體適用勞動基準法，並將其納入為勞基法第84條之1的工作者範圍。 本研究以多元流（multiple streams）視角分析本政策形成之歷程，以探究本政策形成過程，並分析影響本政策決定形成之主因。綜合研究結果與發現，本研究之結論可分為以下三者，首先於本政策形成過程中，問題流、政策流、政治流並非全然獨立地流動，而是會嘗試引導或影響其他流程之發展；又當政策方案被擬定後，特定方案仍有捲土重來或重新被政府檢視或採納之機會；最後，於本政策中並不具明顯擔任政策企業家角色之人，政策窗之所以得以成功開啟，實乃仰賴於各量流逐漸發展純熟，如利益團體長期努力與行動的成果，加上整體政治環境的支持等因素，而促使實現決策的絕佳時間點終於來臨。
並列摘要
In the past few decades, the labor rights of employed physicians were not fully protected, and physicians were like hidden victims trapped in the trap of overwork in the hospitals. Before 2011, the issue of the application of the Labor Standards Act to employed physicians had not attracted the attention of the government authorities. Later, with the burn-out or serious occupational accidents of physicians and the indicators of excessive working hours of physicians, this issue began to arouse relevant groups, public opinion and the media. Therefore, the government authorities began to consider how to protect the labor rights of employed physicians and improve their overwork. However, whether the Labor Standards Act should be applied to employed physicians or not, hospital representatives, relevant government ministries, the employed physicians themselves, interest groups and other multi-actors were inconsistent in this stage from 2011 to 2018. Each actor had their own preferred proposals, but failed to reach a specific policy consensus. Finally, in 2018, with the rotation of the head of the competent authority, and the convergence of the political power of all parties in this issue, the policy window of Application of the Labor Standards Act to Resident physicians was finally opened. It became an excellent time to promote the policy. Finally, the competent authority decided that from September 1st, 2019, the Labor Standards Act only applied to resident physicians . The government authorities included them as workers under Article 84-1 of the Labor Standards Act. In order to explore the policy-making process of this policy and analyze what are the main reasons that influence the formation of this policy decision, this study analyzes the thesis from the perspective of multiple streams approach. The study concludes the three findings. First, this study found that during the formation of this policy, the problem stream, policy stream, and political stream did not flow completely independently, but tried to guide or influence the development of other stream instead. Second, when the policy was formulated, there was still a chance for specific proposals to be reviewed or adopted by the government. Finally, there was no obvious role as a policy entrepreneur in this policy formation process. On the whole, the successful opening of the policy window depended on the gradual development of three streams, such as the results of long-term efforts, actions of interest groups, and the support of the overall political environment. For this reason, the perfect time to make a decision finally arrived.