藥商、醫院與醫師的處方決策:醫療制度與組織面之脈絡分析
Pharmaceutical Industries, Hospitals and Doctors' Prescription Decisions: Exploring the Context of Medical Systems and Organizations
作者:謝幸燕(Hsing-Yen Hsieh) | 首次發表於 2020-06-30 | 第 34 期 June 2005
DOI:https://dx.doi.org/10.6786/TJS.200506_(34).0002
研究論文(Research Articles)
論文資訊 | Article information
摘要 Abstract
本文分析台灣醫師處方決策的製度與組織的脈絡,探討藥商與醫院的管理暨採購制度對台灣醫師處方決策構成的限制與誘因。有許多因素會影響醫師的處方決策,本文的分析焦點是兩個藥商有關的脈絡:醫院採購系統與藥商介入藥品採購的方式對處方決策權的影響;藥商按醫療機構的特性對醫師採取差別化的關係建立策略,讓不同機構層級的醫師在進行決策時面對不同的參考架構。在醫療機構管理權上升的趨勢下,醫師間需協商使用藥品的品項,並接受院方的監督。藥商會針對醫療機構規模的差異,對醫師採取不同的關係策略。在大型醫院中,藥商通常會藉提供資訊、研究經費、無酬勞動力等方式影響醫師的處方用藥。在較小的醫院與診所中,交易主要是透過市場進行,藥商藉財務誘因影響醫師的處方決定。總結來說,台灣醫師的處方決策不必然以專業知識做為參考基準。台灣的醫療體系和醫管制度容許甚至無鼓勵藥商在各級醫院中使用非專業的手法;藥商得提供醫師許多滿足自利動機的選擇。政府推行各項政策以提高醫師專業知識、提升醫療品質的同時,與應留意這些政策在執行上是否過度依賴量化指標,反而擴大了藥商促銷活動的影響範圍,讓醫師面臨更多非專業誘因,對醫師的處方品質産生負面的影響。

關鍵字:處方決策、代理理論、專業規範、製藥業、組織規模
The author investigates the prescription decision-making processes of Taiwanese doctors within the context of the organizational dynamics of hospitals. As hospitals become more aware of their managerial power, the influence of doctors to make specific prescription decisions is being limited in terms of restricting categories and stocking/auditing pharmacy items. At the same time, pharmaceutical companies are using diverse strategies to influence physician choices, offering substantial incentives to large hospitals that provide greater profit compared to small hospitals and local clinics. According to the new Taiwanese model, doctors' prescription decisions are not always based on professional standards but on organizational factors. The medical system allows pharmaceutical companies to fulfill the self-interests of doctors via a combination of professional and non-professional marketing tactics, putting prescription quality in doubt.

Keywords: prescription decisions, agency theory, professional norms, pharmaceutical industry, organizational size
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