Dynamic Analysis of Medical Regulation and Capture Theory-Managed Care in Global Budget System
Date Issued
2007
Date
2007
Author(s)
Lin, Yuh-Chyi
DOI
zh-TW
Abstract
This paper is to explain the procedure of policy-making about medical public affairs. First with the idea of deliberative democracy let people fairly participate and discuss. Then after argument and discussion, people find the way that can solve the problem. However it is unrealistic and impractical to appeal every issue - especially complex, technically oriented issues of National Health Insurance policy to a public process. Therefore regulatory agency (Department of Health) establishes institutional review board (IRB) as inner supervision arrangement. Through the commission negotiation, government settles the impact of vary interest groups. Residents, users of medical resource, urge government make the best policy that they want. Though the medical resource, those will be shared to people equally and justly, belong to country estate, the medical providers not only deliver professional medical care, but also help users allocate and make the best of the medical resource. While IRB function is failure, courts of justice department act as external supervision arrangement. Through decision and justice review, they can correct the arbitrary and abusive discretion of executive agencies.
This paper was written and described from the positive aspect. Retrospectively it initiated the beginning by the issue of government failure and argued the capture theory of regulation. Then it explained the background about lose control of the social insurance and checked regulation entity, ideal of the social welfare, and conflict between public benefits and medical managed care in global budget system. If regulation not fit with requirement of democracy process, unavoidably the interest group will grasp private benefit in the name of public goods.
A reasonable healthcare system grants doctor do his best and deliver perfect medical care as possibly. However the current healthcare policies designed by medical imperialism lead to a manner of corruption because doctors more care their income than benefit of the patient. Even if the radiography is considered not definitely harmful in the dentistry and the other image diagnosis of medicine, in the healthcare system we can not offer the incentives that persuade doctors give up their professional attitude with which they do best for the patient. If there are unjust incentives in the wake of medical commercialization and formalization, finally doctors will abuse radiography and providers will be encouraged to overuse unnecessary radiation.
Therefore in the last half of this paper specially considered are issues related to policy-making of which medical imperialism takes no account.
Substantially there are issues involved with myth of peer review, informed consent, protection of patient private right and privacy autonomy. Through practice of medical lawsuit and analysis of secondary generation National Health Insurance, we can understand there are some spaces in these for further progress in the future.
This paper describes due process and four institutional review boards in the Department of Health, Taiwan. Because medical imperialism takes over the commission, justice review, external supervision arrangement, acts as gatekeepers of National Health Insurance.
However there are special social context with external and inner supervision arrangements. Therefore it is vain for both supervision arrangements to correct market and government failure.
This paper accents a standard procedure of policy-making about medical public affairs. With deliberative democracy and both supervision arrangements the idea of social welfare will come true.
Subjects
審議式民主
全民健康保險
牙醫
告知後同意
俘虜理論
管理式醫療
social welfare
deliberative democracy
National Health Insurance
dentistry
informed consent
government regulation
capture theory
managed care
SDGs
Type
thesis
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