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Title: | 臺灣醫藥分業管制模型的再思考: 邁向共同管制與經濟誘因 Rethinking The Regulatory Model of Separation of Prescribing and Dispensing in Taiwan: Towards Co-Regulation and Economic Incentives |
Other Titles: | Rethinking The Regulatory Model of Separation of Prescribing and Dispensing in Taiwan: Towards Co-Regulation and Economic Incentives |
Authors: | 周冠宇 Guan-Yu Zhou |
Advisor: | 葉俊榮 Jiunn-rong Yeh |
Keyword: | 醫藥分業,命令控制,經濟誘因,國家管制,自我管制,共同管制, separation of prescribing and dispensing,command and control,economic incentives,state regulation,self-regulation,co-regulation, |
Publication Year : | 2022 |
Degree: | 碩士 |
Abstract: | 自1997年正式實施以來,臺灣的醫藥分業始終處於動盪與停滯不前的狀態。在為改善藥品管制環境的背景下,臺灣政府引進了被多數西方國家所採用的醫藥分業作為手段,但由於政府遊走於醫師與藥師兩大利益團體間的態度,以及醫師與藥師間的競爭,造成醫藥分業始終無法順利推行。誠然,法律規範中的缺陷是造成上述困境的原因之一,但更為重要的是,臺灣從日治時期形成至今的社會結構對推動醫藥分業的影響,因其隱含著醫師界為何對醫藥分業產生反感,甚至是抵抗,導致與藥師間產生競爭關係,最終讓政府深陷其中的真正原因。
本文從法律制度與社會脈絡為切入,嘗試勾勒出臺灣在推動醫藥分業中所遭遇之問題的全貌,並對其提出因應策略。本文會先就醫藥分業的前世今生、基本性質與發展現況為說明,並選擇以美國、德國與日本作為例子進行深入剖析,用以檢視與比較臺灣的狀況,同時深入臺灣的社會脈絡從進行觀察,分析問題與其成因,最終提供可行的解決方案及醫藥分業的未來圖像。 本文認為,相較於法制面的問題,臺灣當今的醫療環境與社會結構才是在推動醫藥分業的過程中最難以跨越的坎,從而如何改善,甚至是重新塑造當今的醫療環境與社會結構,成為了通往成功推動醫藥分業的關鍵鑰匙。故本文主張臺灣政府應逐漸放棄現在採取全面主導,以及禁制搭配行政罰的管制手段,轉而與醫師、藥師及人民進行合作,並利用經濟誘因的逐步瓦解既有社會結構,進而建立全新、適合醫藥分業發展的管制環境。 The separation of prescribing and dispensing is a check-and-balance mechanism between physicians and pharmacists. This mechanism primarily aims to improve the security of using drugs, to ensure the income of pharmacists, and to guarantee the right to know of patients. Taiwan, like many other countries, adopted this institutional design to reform its healthcare system. Yet, the promoting process of the separation of prescribing and dispensing in Taiwan has faced many challenges, including the conflicts between physicians and pharmacists, the uncertain attitude of the government, and the complicated social structure. Therefore, the main purpose of this thesis is to provide a feasible solution to improve the healthcare and medical systems of Taiwan. By applying the approach of comparative law research and regulatory theory, this thesis argues that co-regulation and economic incentives can form new regulatory models for Taiwan. The Co-regulation model requires cooperation between the government and private sectors to make public policies, which can help Taiwan’s government to overcome its uncertain attitude. Moreover, the use of economic incentives model can facilitate the separation of prescribing and dispensing. Japan, as a vivid comparative example, adopted the economic incentives model to complete achievements in reforming its healthcare and medical systems. This successful experience from Japan can be an ideal inspiration for Taiwan, which shares many similarities. In addition, this thesis further analyzes that the reasons behind Taiwan's dilemma in promoting the separation of prescribing and dispensing, lies in the complicated social structure between physicians, pharmacists, and patients. This structure leads to the increasing revenue of hospitals by sales of drugs, which makes the physicians unwilling to release prescriptions to community pharmacies. Therefore, how to change this social structure becomes the key to success in the separation of prescribing and dispensing. This thesis argues that the economic incentives model can encourage the physicians to release the prescription by replacing the revenue from the sales of drugs, which serves as a feasible way to promote the separation of prescribing and dispensing. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/83113 |
DOI: | 10.6342/NTU202210068 |
Fulltext Rights: | 同意授權(全球公開) |
metadata.dc.date.embargo-lift: | 2023-02-01 |
Appears in Collections: | 法律學系 |
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U0001-1228221122301012.pdf | 1.97 MB | Adobe PDF | View/Open |
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