醫療政治學

課程概述與目標: 課程概述: 二十世紀末期的台灣民主改革,使民眾自由意志得到最大的發揮。然而,隨著民主化進程的政治亂象與社會失序,使支持民主改革的人,對政治產生新的疏離感。2000年首次的政黨輪替至今,台灣已再經歷過六次總統大選及第三次政黨輪替。2016年的政黨輪替民進黨完全執政,卻因年金改革與九二共識,遭遇2018年的亂流,2020年蔡英文總統以817萬票的絕對多數獲得連任。馬政府八年執政,中央衛生主管五度更迭,民進黨執政五年餘,也已兩度更換衛生福利部部長,去年開始的COVID-19疫情,產生「順時鐘」的民意趨勢,在疫情變化快速的時代,「順時鐘」與「逆順時」來回轉換,也到了面臨新的衛生福利部長的時候。 1995年三月一日實施的全民健康保險,醫療制度與資源在健保體制下持續面臨壓縮與調整,臺灣的醫療體制幾乎已是健保取向。醫界在健保體制下,專業的危機感更深,但也缺乏自省與遠景。二代健保附加捐支撐健保安全準備金,血汗醫院的事件,仍然層出不窮。2020年的總統選舉中,健保第一次不是重大公共政策的議題,2021年的健保保費調漲,也沒造成政府施政的危機。2024年健保財務必將再度浮上選舉檯面。台灣社會與醫界仍瀰漫著願景未定的焦慮,從兩岸衛生醫療合作、為觀光醫療到再生醫療、精準醫療,這些都無法迴避台灣醫療服務非營利的本質。 衛生福利政策以及衛生醫療、健保資源之分配與角力,難脫政治社會層面與醫師專業優勢之影響,但是在健保體制下,台灣進入老年化的社會,加上基因科技的興起,二十一世紀的台灣衛生醫療,面臨前所未見的挑戰。醫療政治學之課程設計即是探討政治與衛生醫療各領域之互動及其影響。 本課程主要內容分為四個主題: 一、台灣政治發展的宏觀面與醫療政治的微觀面 二、衛生政策與醫療資源分配的政治面 三、生技製藥產業與兩岸醫藥合作的政治議題 四、國際衛生與本土衛生之政治議題。 課程進度包括:領導風格與衛生政策;健康照護權利與醫療資源分配之政治考量;醫師專業優勢、醫療專業、利益團體與政治勢力之互動;菸草產業的政治影響力與菸害防治;生技製藥產業的發展與學名藥品的競爭;創新醫藥的可近性;醫療執業之倫理與政治涵意;人權、經濟發展、醫療與製藥產業結構;國際衛生與本土衛生之政治課題。 課程目標: 培養修課學生從宏觀政治面瞭解醫藥衛生政策相關的議題,從閱讀文獻與課堂討論,瞭解醫療衛生政策形成與執行過程受政治層面的影響,進而厚植對醫藥衛生政策的知識基礎。 The democratic reform of 20th Century in Taiwan liberated and maximized the free will and mind of Taiwanese people. However, new political apathy and alienation among the people who have been supportive of the democratic reform surfaced amid political chaos and social disorders. There has been six presidential elections and third transfer of power since the first transfer of power in 2000. For the first time, the Democratic Progress Party (DPP) were in majority control of the Legislative Yuan in 2016, but it was met with tumultuous setback in 2018 due to the pension reform and so called ’92 Consensus’. President Tsai Yin-Wen was elected for the second term with commanding majority of 817 thousand votes in 2020. During the eight years of President Ma’s administration, there were five turnovers of the Ministry of Health (and Welfare), there has been two changes of the Minister of MHW under DPP administration since 2016. The COCID-19 pandemics since 2020 generated the phenomena of ‘Clockwise Chen’ in public poll. However, the rapidly changing COVID-19 pandemic since May of 2021 has reflected in the ‘Clockwise Chen’ and ‘Counter -Clockwise Chen’ alternatively in public surveys, and it’s the time for a new Minister of Health and Welfare. The effectiveness of the Universal Health Coverage (National Health Insurance) in Taiwan since March 1st, 1995, resulted in the pressure and adjustment of healthcare system and medical resources. Taiwan’s healthcare system therefore became very much NHI-oriented. The self-aware professional crisis deepened among the medical community and has been lacking intra-professional thoughts and vision. The supplementary premium on National Health Insurance provided the Safety Reserves of the NHI since the 2nd Generation NHI became effective. However, continued narratives related to the blood-and-sweat hospitals still kept surfacing. For the 1st time in Taiwan’s presidential election, NHI was not on the agenda of the presidential debates in 2016, and no governmental crisis was raised even amid the increase of NHI in the following year (2021). The NHI financial issue certainly will be reappeared in the coming 2024 presidential election. The society as a whole and medical community continued to live in uncertainty of anxiety that can be reflected in the issues of the Cross-Strait medical cooperation, medical acre tourism, regenerate and/or precision medicines regardless the de facto reality that health care in Taiwan has been regulated on not-for-profit basis. The health and welfare policy, health care and related distribution of resources are not immune of socio-political intervention and physician-dominated influences. It is also facing tremendous challenging in the 21st Century due to sustainable NHI system, aging society, advancement of life sciences, particularly in gene-related technology. The course of Healthcare Politics us designed to elaborate the issues surrounding politics and healthcare interaction on related various aspects. This course is divided into four themes: 1. Macro/micro-aspect of political development and healthcare development in Taiwan。 2. The political aspects of the distribution of healthcare resources and its politics. 3. Politics in biopharmaceutical industry, cross-strait medical cooperation issues. 4. International health and domestic health politic. The agenda of the class include: Leadership and health policy, Rights to healthcare and the politics of resource distribution, Interaction of Physician dominance, health professions, stakeholders and politics, Politics in Tobacco Hazards Control, Development of biopharmaceutical industry and generic competition, Accessibility on innovative medicines, Ethic and political implications of medical practices, Human rights, economic development, healthcare and pharmaceutical infrastructure, Politics in international health and domestic healthcare. Objectives of the Course: To prepare the students to understand the political aspects of healthcare policies through literature, reading materials and class discussions. It is purported to provide fundamental knowledge on the political influences on healthcare policy formulation, implementation and the outcomes.

無 No pre-requirement

1.學期作業、考試、評量 主題辯論(期末主題討論)25%、上課參與及討論(繳交學習心得)25%、作業(選定專題報告主題及繳交期末報告)50%。 2.教學方法及教學相關配合事項(如助教、網站或圖書及資料庫等) 閱讀指定文獻與資料,上課中發言參與討論及主題辯論,並分組進行專題報及繳交期末報告;選課學生一學期請假或缺課不得超過三次,否則無法給予學期分數,如因學生時間安排困難,建議退選或改為旁聽;學生繳交上課心得,每次加分0.5分,最多加分5.0分。Students are obliged to read the assigned reading and literature, questions and discussion during class, group organized for term paper topic and works are encouraged. Those students who select this course but are absent from class attendance for more than 3 times shall not receive the Semester Final Grade. The students who have difficulties in class attendance may choose auditor status to this class. Each short assay submitted is entitled to have 0.5 score to the final grade score, maximum 5.0 in total.

主題辯論(期末主題討論)25%、上課參與及討論(繳交學習心得)25%、作業(選定專題報告主題及繳交期末報告)50%。 Narratives on lecture themes(Theme topic discussion)25%、Class presence and engagement(Short essays on learning)25%、Term Paper(Select topic for term paper work)50%。

• 二、衛生政策與醫療資源分配的政治面 2. The political aspects of the distribution of healthcare resources and its politics.
• 三、生技製藥產業與兩岸醫藥合作的政治議題 3. Politics in biopharmaceutical industry, cross-strait medical cooperation issues.
• 四、國際衛生與本土衛生之政治議題。 4. International health and domestic health politic.
• 一、台灣政治發展的宏觀面與醫療政治的微觀面 1. Macro/micro-aspect of political development and healthcare development in Taiwan.

本課程指定閱讀資料負荷,平均每星期進度的資料閱讀英文約30~50頁,如為中文資料則50~100頁。 指定閱讀資料: 第1週 09/12 課程大綱與指定閱讀資料書目、細節說明及討論;醫療政治學的領域 第2週 09/19 領導風格與衛生政策~歷任生署長(衛生福利部部長)的政治歷練 第3週 09/26政治學導讀 1. Ranney A. Governing – An Introduction to Political Science (政治學,台北雙葉書廊中譯本(1995年6月),英文第八版為2001年,或坊間一般政治學概論的入門教科書 第4週 10/03政治發展與衛生醫療政策之間的相關性 2. Saltman RB and Ferroussier-Davis O. The concept of stewardship in health policy. Bulletin of the WHO, 2000; 78: 732-739. 3. Gostin LO. The Politics of AIDS: Compulsory State Power, Public Health, and Civil Liberties. Georgetown University Law Center, 1989. 第5週 10/10國慶日放假 第6週 10/17 菸草產業的政治影響力與菸害防制 4. 菸草控制框架公約台灣FCTC報告。In:2014台灣菸害防制年報,衛生福利部國民健康署出版,2014年12月。Available from: http://www.tabacco.hpa.gov.tw/Show.aspx?MenuId-4 5. 煙草圖冊第三版(Tobacco Atlas 2009). Available from: http://www.tobaccoatlas.org/downloads/TA-ch.pdf 第7週 10/24 健康照護制度的評估 6. Health Systems: Improving Performance—The World Health Report 2000. Geneva: World Health organization, May 2000. 7. Research for Universal Health Coverage ~ The World Health Report 2013. Geneva: World Health Organization, May 2013. 第8週 10/31 精準醫療相關法規的倫理與法律議題 8. Genetics Home Reference: Help Me understand Genetics- Precision Medicine. Available form https://ghr.nlm.nih.gov/primer/precisionmedicine/definition. 8.1 J Minari, KB Brothers and M Morrison: Tensions in ethics and policy created by National Precision Medicine Programs. Human Genomics (2018) 12:22. 9. 再生製劑管理條例草案 10. 特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法 第9週 11/07 藥品專利、學名藥與原廠藥的競爭 11. Jeremy A. Greene: Generic ~The Unbranding of Modern Medicine. Johns Hopkins University Press, 2014.(林士堯譯:便宜沒好藥?左岸文化出版,2018年7月出版。) 12. Katherine Eban. Bottle of Lies: The Inside Story of the Generic Drug Industry Boom, HarperCollins Publishers, 2019. (高子梅譯:謊言之瓶,臉譜出版社,2021年5出版。) 第10週 11/14 人權與醫療 13. Medical Ethics and Professional Standards. In: The Medical profession and Human Rights: Handbook for a Changing Agenda. British Medical Association 2001, p. 1~13. 14. Ethics, Morals, Right and Needs. In: The Medical Profession and Human Rights: Handbook for a Changing Agenda. British Medical Association 2001. p. 14~p.42. 第11週 11/21 難以面對的健保藥價差情結 15. 健保藥品給付項目與支付標準,衛生福利部中央健康保險署。 16. 黃文鴻:難以面對的「健保藥價差」情結,健康保險(楊志良主編),文華圖書管理資訊(股),108年元月初版,p. 345~358。 第12週 11/28 全民健保的政治分析(張鴻仁教授特別演講) 17. Revealed: Countries With The Best Health Care Systems, 2019. CEO Magazine, 16, 2019, p.1~5. 18. 衛生福利部二代健保總檢討簡報及總報告。 第13週 12/05 國際衛生組織、衛生合作與援助;兩岸醫藥合作的政治議題 19. 海峽兩岸醫藥衛生合作協議,衛生福利部。 20. 詹長權、黃文鴻:第十五章 國際衛生與未來展望。陳拱北預防醫學基金會總策畫:公共衛生學(上冊)。2015年6月修訂五版,台大出版中心,pp.369~405。 第14週 12/20 台灣生技製藥產業發展的政治議題 21. WTO Agreements and Public Health – A Joint Study by the WHO and the WTO Secretariat. Geneva: WHO, August 2002. pp.1-171. 第15週 12/27 醫療法律與大法官釋憲 22. 司法院大法官釋字第778號-醫藥分業下之醫師藥品調劑權案的解釋 The assigned weekly reading materials in this course are 30~50 pages in English and 50~100 pages in Mandarin Chines on the average. Reading assignment: W1(09/12) Syllabus, Assigned readings and Briefing on Class progress;Domains of healthcare politics W2(09/19) Leadership and Health Policy ~ Political tenures of Health (and Welfare) Ministers W3(09/26) Introduction to Politics 1. Ranney A. Governing – An Introduction to Political Science (Chinese edition, 台北雙葉書廊中譯本(1995/6) ,English 8th Edition (2001), or any Textbook on Introductory Politics available. W4(10/03) Relationship between healthcare policy of political development 2. Saltman RB and Ferroussier-Davis O. The concept of stewardship in health policy. Bulletin of the WHO, 2000; 78: 732-739. 3. Gostin LO. The Politics of AIDS: Compulsory State Power, Public Health, and Civil Liberties. Georgetown University Law Center, 1989. W5(10/10) National Holiday W6(10/17) Political influences of tobacco industry and Tobacco Hazzard Control 4. Taiwan TCTF Report. In: 2014台灣菸害防制年報,衛生福利部國民健康署出版,2014年12月。Available from: http://www.tabacco.hpa.gov.tw/Show.aspx?MenuId-4 5. Tobacco Atlas 2009). Available from: http://www.tobaccoatlas.org/downloads/TA-ch.pdf W7(10/24) Evaluation of Health Systems 6. Health Systems: Improving Performance—The World Health Report 2000. Geneva: World Health organization, May 2000. 7. Research for Universal Health Coverage ~ The World Health Report 2013. Geneva: World Health Organization, May 2013. W8(10/31) Precision Medicine: Issues in Ethics and Regulations 8. Genetics Home Reference: Help Me understand Genetics- Precision Medicine. Available form https://ghr.nlm.nih.gov/primer/precisionmedicine/definition. 8.1 J Minari, KB Brothers and M Morrison: Tensions in ethics and policy created by National Precision Medicine Programs. Human Genomics (2018) 12:22. 9. Draft of the Regenerative Medicines Law(再生製劑管理條例草案) 10. Special Therapy Regulation(特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法) W9(11/07) Patents and Competition between Generic Drugs and the Originators 11. Jeremy A. Greene: Generic ~The Unbranding of Modern Medicine. Johns Hopkins University Press, 2014.(Chinese edition 林士堯譯:便宜沒好藥?左岸文化出版,2018年7月出版。) 12. Katherine Eban. Bottle of Lies: The Inside Story of the Generic Drug Industry Boom, HarperCollins Publishers, 2019. (Chinese edition高子梅譯:謊言之瓶,臉譜出版社,2021年5出版。) W10(11/14) Human Rights and Healthcare 13. Medical Ethics and Professional Standards. In: The Medical profession and Human Rights: Handbook for a Changing Agenda. British Medical Association 2001, p. 1~13. 14. Ethics, Morals, Right and Needs. In: The Medical Profession and Human Rights: Handbook for a Changing Agenda. British Medical Association 2001. p. 14~p.42. W11(11/21) Dilemma of the NHI Pharmaceutical Payment Gap 15. NHI Pharmaceutical Benefits and Reimbursement Scheme(健保藥品給付項目與支付標準,衛生福利部中央健康保險署) 16. Huang WF: The NHI Pharmaceutical Payment Complex (In Chinese)難以面對的「健保藥價差」情結,健康保險(楊志良主編),文華圖書管理資訊(股),108年元月初版,p. 345~358。) W12(11/28) Political Analysis of the NHI (Special Lecture by Dr. HJ Chang) 17. Revealed: Countries With The Best Health Care Systems, 2019. CEO Magazine, 16, 2019, p.1~5. 18. Summary Report of 2nd Generation NHI(衛生福利部二代健保總檢討簡報及總報告。) W13(12/05) Politics in International Health Organization, Cooperation and Aids; Cross-Strait Health Cooperation 19. Cross-Strait Medical and Pharmaceutical Cooperation Agreement, MOHW (海峽兩岸醫藥衛生合作協議,衛生福利部)。 20. Perspectives of International Health (In Chinese詹長權、黃文鴻:第十五章 國際衛生與未來展望。陳拱北預防醫學基金會總策畫:公共衛生學(上冊)。2015年6月修訂五版,台大出版中心,pp.369~405。) W14(12/12) Political Issues of Biopharmaceutical Development in Taiwan 21. WTO Agreements and Public Health – A Joint Study by the WHO and the WTO Secretariat. Geneva: WHO, August 2002. pp.1-171. W15(12/19) Supreme Court Constitutional Decisions in Healthcare Cases 22. The Separation of Medical Practice and Prescription Dispensing, Supreme Court Decision No. 778 (司法院大法官釋字第778號-醫藥分業下之醫師藥品調劑權案的解釋)

地點

衛生福利研究所611教室 Class room 611, Institute of Health and Welfare Policy

時間

每星期一課後3:20~4:00PM After class hour (3:20~4:00PM) each week, appointment required.

聯絡方式

hwf8011@nycu.edu.tw