| Summary: | 博士 === 國立中正大學 === 社會福利所 === 96 === Since the Global Budget System of National Health Insurance, medical institute used to save life has gradually turned such medical system with the trend of becoming private and market-oriented enterprise. Therefore, the last frontier of “ethics” for medical treatment in Taiwan has been completed collapsed by capitalism, and it has rendered the entire community to suffer and hindered the research, development, and progress of medicine, aside from merely beneficial to capitalist. Under the trend that development of medical treatment “heads towards money,” one would wonder if such context would keep doctor aloof, or erode the moral standards as expected of people upon doctor and distort the sense of value that medical school inculcates upon them.
We should further appreciate the problem of medical treatment cost when Global Budget System was implemented in Taiwan, and if it would, indeed, affect rational distribution of medical treatment resources, social justice and medical treatment behavior, and patient’s right for medical consultation. This paper will, aside from literature investigation, analyze the pros and cons of criticism from many scholars as they discuss how the costs of medical treatment should affect the justice, ethics, and social responsibility of doctors. Meanwhile, it would resort to in-depth interview of doctor and patient to view respectively the difference of medical treatment and doctor-patient behavior so as to examine the views of doctor and patient regarding the implementation of total payment system. As such, we can see if the medical treatment behavior of doctor is affected and conventional sense of value for medical education eroded under this cost control mechanism of medical treatment so as to echo with scholars who are concerned that the control of medical treatment might have affected the justice and ethics of doctor. It is further hoped that treatment of soul is better than illness, and we do hope that balanced development of medical treatment ecology can be achieved to render rights of health of the mass with greater protection.
As found form the study, when the Global Budget System was implemented it has seriously affected the behavior of doctors to issue high-priced prescription because many hospitals have to consider the cost consideration of medical treatment. Critical patients staying at hospitals have either become human balls of medical treatment or have to be evicted early, and it has created the problem finding suitable of medical talents for the medical treatment of critical illness in need of massive medical expenses. As such, patient for appendicitis operation might have to wait for months with procrastination in the future. Besides, it has become more and more difficult to split a share of medical treatment resource under limited medical resources, and some doctors will, in coping with autonomous management mechanism of financial independence, render medical behavior in violation of justice. As a result, it will not only further burden the economic load of the underprivileged and the senior, but also turn these groups not to pursue with partial-payment medication or medical treatment that is beneficial to self-health. Nonetheless, these minority groups under the poverty line might, under social security policy of countries, obtain government subsidies. But the most impoverished group would be the minority senior from the middle and lower-income family as they are only financially limited but could not locate suitable work, not to mention that they can afford the partially –paid medical treatment expenses.
To avoid that the rights of the mass would be jeopardizes, the Health Insurance Bureau should, first, see to the problem of rational payment of medical treatment. As for current health instance system, equality payment of medical treatment would surely affect the behavior of doctor for consultation. Besides, we should reckon if “withdrawal mechanism” should be set up so that poorly managed medical service institute is excluded to strive for health insurance expenses with the better-performing medical service institute. As a result, the provider of medical treatment can be more focused on providing more comprehensive medical treatment service.
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