台灣公共衛生體系市場化與醫療化的歷史發展分析

The Analysis of the Historical Development of Marketization and Medicalization of the National Public Health System in Taiwan

陳美霞(Meei-Shia Chen)

《台灣社會研究季刊》 81期 (2011/03) Pp. 3-78

https://doi.org/10.29816/TARQSS.201103.0001

摘要

2003年SARS流行對台灣經濟及社會的沈重打擊，暴露公衛體系的種種問題，本文分析其中市場化及醫療化這兩類問題。目前台灣公共衛生或醫療相關學術研究文獻，尚未對此兩大問題做過系統分析；此外，這兩類問題，幾乎都是分開被不同的人，不同的文章提出的，亦即，一般認為這是兩個互不相關的問題。以歷史的考察為主要研究取徑，本文作者指出，台灣公共衛生體系的醫療部門從光復後至今—尤其在1980年代之後，是不斷商品化、市場化的過程；而公衛體系則是不斷醫療化的過程，這個過程也是在1980年代後加速進行。作者進一步提出，公衛體系的這兩大問題不但相關，甚至有共生的關係︰即，要是公衛體系的醫療部門不過度市場化，它過度醫療化的問題不會存在；反之，要是公衛體系不將健康問題醫療化，醫療部門過度市場化的問題不易產生。兩者共生互促共息，缺一無以為繼。

關鍵字

醫療化 ； 市場化 ； 共生關係 ； 公共衛生體系 ； 台灣 ； 醫療體系

並列摘要

The outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 had an enormous economic and social impact on Taiwan. It revealed that Taiwan's public health system had many problems. Of these problems, this paper analyzes two major ones: its marketization and medicalization, for which the health and medical literature in Taiwan lacks a systematic analysis. Moreover, these two issues were mostly raised separately by different researchers or commentators, and treated as un-related problems. Using a historical inquiry approach, the author argues that the medical sector of Taiwan's public health system has been continuously commodified and marketized since Taiwan was returned to China from the colonial Japanese government. The pace of this marketization process has been particularly fast starting from the 1980s. In the same period, Taiwan's public health system has also been continuously medicalized and this process has also been much faster. The author further argues that the marketization and medicalization processes are not only related but also have symbiotic relationships. On the one hand, the over-medicalization of the public health system would not have occurred if the medical sector was not over-marketized; on the other, the over-marketization of the medical sector would not have occurred if Taiwanese people's health problems were not medicalized. These two problems have a mutually beneficial relationship; without one, the other would not have continued.

並列關鍵字

medicalization ； marketization ； symbiotic relationships ； national public health system ； Taiwan ； medical care system

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