臺灣醫政關係演化之論述分析—以《臺灣醫界》(1958~2010)為例

Discourse analysis about evolution of the medical-political relation in Taiwan. On the narratives in Taiwan Medical Journal (1958 - 2010)

阮怡嘉(I-chia Juan)

指導教授 ： 黃敏原

中山醫學大學/醫學人文暨社會學院/醫學社會暨社會工作學系碩士班/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00116

摘要

政治和醫療對於一個社會的組成具有極大的影響力，而醫政之間的關係更是錯綜複雜且牽涉極廣；從既有的文獻中已可以了解過去臺灣社會當中政治如何影響醫療體系的發展，但鮮少有以醫界視角為主體的文獻內容。有鑒於此，故本研究選擇1958至2010年由中華民國醫師公會全國聯合會出版的《臺灣醫界》雜誌為研究場域，將與醫政相關之內容分成三大時期：「威權時期」(1958~1978)、「民主發展時期」(1978~1995)、「全民健保開辦後」(1995~2010)，與「維護醫界權益」、「政策論述」、「宣揚政令」、「政治論述」四大主題，以論述分析為研究方法進行雜誌中不同時期的醫政關係演變探討。

　　經論述分析後發現臺灣醫政關係的演變過程：威權時期的「以政領醫」，民主發展時期的「醫權漸長」，全民健保開辦後陳水扁總統第一任任期的「醫政相持」發展至二ＯＯ四年後的醫政「各取所需」，這樣的醫政關係是一個動態且受政治社會脈絡影響的演變過程；研究中也發現臺灣政治風氣的封閉與開放、公會理事長的個人風格、政黨傾向、與執政者間的親密度、牽扯利益的性質與切身程度，皆是本研究認為影響「醫政關係」之主要因素。文章最後提出討論及建議，期待能作為未來臺灣醫政關係研究的基石。

關鍵字

醫政關係 ； 《臺灣醫界》 ； 全民健康保險 ； 醫藥分業 ； 以政領醫 ； 醫權漸長 ； 各取所需

並列摘要

Politics and medical care have great impacts on the social structure, while the medical-political relations are complicated and involves lots of aspects. From the existing literatures, it can be learned how Taiwan’s politics affected the development of its medical system in the past; however, there are relatively few studies done from the perspective of the medical circle. Hence, this paper takes the Taiwan Medical Journal published from 1958 to 2010 by the Taiwan Medical Association as the research field and divides the contents related to its medical-political relations into three stages: the period of authoritarian regime (1958~1978), the period of democratic development (1978~1995) and the period after carrying out the National Health Insurance. It adopts “safeguarding the rights and interests of the medical circle”, “policy discourse”, “advocating governmental decree” and “politics discourse” as subjects and discourse analysis as the method of research to explore the evolution of the medical-political relations during the different periods.

According to the discourse analysis, the medical-political relation changes in Taiwan can be learned from the ideas of “guiding medical care with politics” in the authoritarian period, going through the “gradual growth of medical rights” in the period of democratic development, to those in the period after carrying out the National Health Insurance like the “mutual support of medical care and politics” during the first presidency of Chen Shui-pien and the idea of “each taking what it needs” since 2004. The evolution process of medical-political relations is dynamic and influenced by the political societies. During the research, the author also finds that the main factors influencing medical-political relations include the closed and open political climates of Taiwan, the personal style and partisan preference of the director of the association, and the degree of intimacy with the rulers, property of interests involved and degree of immediate concern. In the end, this paper proposes discussions and suggestions, expecting to serve as the foundation for studies related to Taiwan’s medical-political relations in the future.

並列關鍵字

Medical-political relations ； Taiwan Medical Journal ； National Health Insurance ； separating drugs from medical care ； guiding medical care with politics ； gradual growth of medical right ； each taking what it needs

參考文獻

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