生老病死是每一個人必經的歷程，身處在現代社會，我們一生之中，一定有某個階段會接觸到醫療專業。醫學科學從啟蒙時期以來的快速發展，細菌致病原的發現與抗生素使許多傳染性疾病受到控制，移植與關節置換手術使受損的器官得以更換，死亡率與健康狀況獲得普遍的改善，開啟了二戰後的醫學黃金時代。現在可以說是醫學，而不是宗教或法律，主宰我們的出生、死亡與生活品質。然而，新公共衛生運動所訴求的幸福狀態，模糊了公共領域與私人生活之間的界線；疾病從急性傳染病轉為與生活型態相關的慢性病，生活環境中不斷強化的風險增加了個人的脆弱感。加上以病人為中心的醫療模式轉向，消費者意識抬頭，導致70年代末期以後，醫學黃金時代的逐漸褪色。近年來醫療與保險費用不斷上漲，個人對自身健康卻更沒有信心，使醫療專業遭受到越來越多質疑與挑戰。
醫學專業隨著科學技術與社會文化而變遷，一般民眾的生活越來越脫離不開醫療制度與醫學專業組織。醫學透過組織建立其專業地位與民眾進行互動，而各醫療專業組織又受到整體醫療制度的影響與制約。全民健保是台灣歷年來民眾滿意度最高的政策，實施二十年來，政府自滿於低保費、高納保率的台灣經驗，人民卻開始抨擊昂貴的自費以及低落的醫療品質，更大的隱憂在於因健保給付過於低廉所導致醫院服務量失控的血汗現象，大批護理人員逃離醫療職場，年輕醫師不願從事急重症醫療等結構性崩壞。然而，醫療崩壞的原因只在於全民健保的餅不夠分嗎？只因為醫院評鑑的文書作業惱人嗎？
當做為一種制度的醫學無法滿足我們的內心期望和需要時，反映出來的是，現代醫學科學的實作與制度和人們對於健康的主觀認知之間的落差。Richard Scott將制度定義為：「受規章、規範及認知體系制約的結構和活動，這些結構和活動使社會趨於穩定，並使社會行為產生意義。」。現代醫療專業組織是一種醫療專業與行政管理的雙軌式科層組織，必須滿足各種法令規章與醫學倫理規範，而文化認知形塑的圖式更是醫病之間互動的腳本，提供理解醫療場域的微觀基礎。
本課程分為兩大部分，先從制度與組織的理論出發，簡介組織社會學的理論發展與流派後，將重點放在新制度理論，進行制度構成要素與組織場域的探討。第二部分為台灣與國際醫療制度，討論醫院的組織運作如何受到全民健保與醫院評鑑制度的影響，以醫療場域中各種行動者分析，提供醫學與社會內在關係的理解。Birth, old age, sickness and death are a must-see journey for everyone. In modern society, we must have a certain stage of our lives to be involved in medical professions. The rapid development of medical science since the invasion period, the discovery of bacterial pathogens and antibiotics have brought many infectious diseases under control, transplantation and coordination surgery have allowed the sucked organs to be replaced, mortality and health conditions have generally improved, and the golden age of medicine after the Second World War was launched. Now it can be said that it is medicine, not religion or law, that dominates our birth, death and quality of life. However, the state of happiness accused by the new public health movement blurs the boundary between the public domain and private life; the disease turns from acute infectious diseases to chronic diseases related to lifestyle, and the continuous strengthening risks in the living environment increase personal sense of fragility. Coupled with the patient-centered medical model, consumers are consciously raising their heads, leading to the gradual fading of the Golden Age of Medicine since the late 1970s. In recent years, medical and insurance expenses have continued to rise, and individuals have less confidence in their own health, which has caused medical profession to be increasingly doubted and challenged.
The medical profession has changed with scientific technology and social culture, and the lives of ordinary people are increasingly separated from the medical system and medical profession. Medicine establishes its professional status through organizations and interacts with the public, and various medical professional organizations are affected and contracted by the overall medical system. National health insurance is the most satisfying policy in Taiwan. In the past 20 years, the government has been fully committed to Taiwan's experience of low-income insurance and high-income insurance rates. The people have begun to criticize their expensive self-payment and low medical quality. The greater concern is the blood and sweat phenomenon of out-of-control hospital services caused by low health insurance payments. A large number of nursing staff have fled from medical field, and young doctors are unwilling to engage in emergency and severe medical treatment and other structural collapses. However, the only reason for medical collapse is that the nutritional content of national health insurance is not enough? Is it because the literature and literature reviewed by the hospital is a guru?
When medicine as a system cannot meet our inner expectations and needs, it reflects the gap between modern medical science’s practice and institutions and people’s awareness of health. Richard Scott defines the system as: "The structures and activities that are subject to regulations, regulations and recognition systems that make society stable and make society behave in business." Modern medical professional organizations are dual-level scientific organizations of medical professionals and administrative management, which must meet various legal regulations and medical ethics. The cultural cognitive shaping diagram is an interactive script between medical diseases, providing a micro-conceptual basis for understanding the medical field.
This course is divided into two parts. First, it develops from the theory of institutions and organizations, and briefly introduces the theoretical development and schools of organizational society, and focuses on the new institutional theory and conducts exploration of institutional structure elements and organizational fields. The second part is Taiwan and international medical systems, discussing how the organizational operations of hospitals are affected by the universal health care and hospital evaluation system, and using various actors in the medical field to provide an understanding of the internal relationship between medicine and society.
主要書目
Scott, W. R. (2013). Institutions and organizations: Ideas, interests, and identities. 4th edition, Sage Publications.。
中譯本：Richard Scott (姚偉譯)，2010，制度與組織︰思想觀念與物質利益 (3rd edition)，中國人民大學出版社。
Main books
Scott, W. R. (2013). Institutions and organizations: Ideas, interests, and identities. 4th edition, Sage Publications.
Chinese translation: Richard Scott (Yao Wei), 2010, Institutions and Organizations: Ideological Concepts and Material Interests (3rd edition), China People's University Press.
| 評分項目 Grading Method | 配分比例 Grading percentage | 說明 Description |
|---|---|---|
| 平時表現平時表現 Normal performance |
30 | |
| 期中考期中考 Midterm exam |
30 | |
| 期末考期末考 Final exam |
40 |
