醫療品質資訊： 與民眾有何相干？

1. 醫療品質資訊：與民眾有何相干？ 張苙雲 中央研究院社會學研究所 台灣醫療改革基金會 2006/6/2

2. Providers and Patients • An observable but not contractible service –quality • A nonretardable service • An asymmetric-information context

3. Providers and Patients • Whereas most physicians will act in the patients best interest when the medical decision is clear cut, the effect of financial incentives may be more important in areas where the correct decision is not clear.”—by Alan L. Hillman (1990)

4. 醫療品質 • ＝ 價值觀＋醫療文化 ＋溝通（病患、家屬、醫護人員有交集） ＋組織設計與醫療設備 ＋專業能力

5. 三個層次的思考 • 面對集體的民眾：社會 • 價值觀與醫療文化 • 面對集體的病人：醫療照護組織 • 溝通、專業能耐、管理能耐 • 面對個別病人：醫病之間的溝通（整體性）

6. Patient-Medical Professional Encounters • Continuity of care • Educational resources—Self management and compliance

7. A Refutable Assumptionand a Refutable Reaction • 病人童稚 • 非黑即白的二分取向： 醫界的鐘擺現象

8. Safeguarding the Quality of Care • Behind the scene: Organizational Design Professional, management, and technical competency and free of moral hazard

9. Safeguarding the Quality of Care • Embeded in the organizational design • Continuity of care • Better organization • Practice of medical interviewing • Marshalling of the knowledge : • Practitioner has more relevant information about the patient • Patient with knowledge to fight the disease

10. What Should Patients Know? • Patients should know • what they are entitled to know. • What they are able to comply with medical orders. • What they are able to be empowered for self-management and self-care. • All are at the level of patient and medical practitioner encounter.

11. What Should the General Public Know? • Social Obligation • Are the providers trustworthy? • At the hospital level: • Competency • Moral hazard • Remedial effectiveness

12. Tentative Conclusion? • 衛教了幾十年，醫療院所越來越像五星級旅館 • 民眾，仍然醫療幼稚園就學中 • 民眾學學習能力太差？ • 從Learning outcomes來看 • 教的人是不及格的

13. Tentative Conclusion? • 民眾很難區辨值得信賴的醫院？ • 代理民眾管理的政府單位，是否比較清楚狀況？ • 政府和醫療機構需要面對民眾嗎？ • 需要對民眾負責嗎？ • 價值觀與醫療文化