管理式醫療照護下的醫病信任議題

Issues of Trust between Physician and Patient in Managed Care

江弘基(Hung-Chi Chiang) ； 李蘭(Lan-Lee Yen)

《Journal of Medical Education》 7卷2期 (2003/06) Pp. 95-105

https://doi.org/10.6145/jme.200306_7(2).0002

摘要

在醫療費用高漲及財務有限的壓力下，世界各國爭相仿效管理式醫療照護的做法，然而根據美國近年來的實際情況，管理式醫療照護使民眾對醫療體系與醫師的信任感降到谷底。在限制病人就醫的重重管制措施下，傳統醫學倫理中病人至上的宣言，已不必然能為醫師取得病人的信任。醫師如何面臨專業堅持與經營績效的兩難，乃維繫醫病信任關係的重要關鍵。本文說明管理式醫療照護對醫師產生的衝擊，並藉由分析醫病「信任」的本質及成立的條件，探討問題的可能出路，以供國內參考。

關鍵字

管理式醫療照護 ； 信任 ； 醫學倫理 ； 專業化

並列摘要

Under tremendous financial pressure, many countries have adopted managed care or a similar technique as a method by which medical costs can be contained. However, experience in USA has shown that trust between physician and patient has become one of the most contentious issues under current managed care systems. Are the teachings and virtues of the Hippocratic Oath, which is the starting point of traditional medical ethics, sufficient to resolve conflicts that now face health professionals? It is the purpose of this article to introduce and discuss the concept and nature of “trust”. These will be used to propose potential ways, as recommended by medical ethics philosophers, by which the physician-patient relationship can be rebuilt. As Taiwan’s National Health Insurance is moving toward a type of managed care delivery system, these issues of trust deserve more attention in Taiwan.

並列關鍵字

Managed care ； trust ； medical ethics ； professionalization

參考文獻

Quoted by Media coverage on Conference of "Trust Initiatives", School of Public Health, Harvard University

林恆慶、黃子芬、李照軒(2001)。管理式醫療介紹。臺灣衛誌。20(5)，331-336。

吳堯達、張伊萍、林恒慶(2002)。論管理式醫療的利弊得失。醫院。35(6)，47-55。

江東亮、胡德偉(2000)。美國發展管理式照護的經驗與啓示。中華衛誌。19(5)，340-355。

黃明和、吳重慶、顏裕庭(2002)。管理醫療的挑戰。臺灣醫界。45(5)，52-55。