新管理主義對於醫院醫療服務之影響：給醫務社會工作的啟示

The Impacts from New Managerialism on Hospitals' Medical Services - Implication for Medical Social Work

侯建州(Chien-Chou Hou)

醫務社會工作 ； 新管理主義 ； 醫療服務 ； 醫院管理 ； 專業發展 ； Medical social work ； New managerialism ； Medical service ； Hospital management ； Professional development

臺灣社會工作學刊

21期（2018 / 12 / 01）

37+39 - 78

繁體中文

新管理主義的思潮與效應在各界發生，所造成的影響也改變了健康照顧領域內醫院醫療服務，甚至間接影響著醫務社會工作。本研究欲探討新管理主義對於醫院醫療服務的影響，採取質化研究取向，以分層立意取樣後，進行個別深度訪談，又因本研究同時欲分析對於醫務社會工作的啟示，故訪談對象有醫院高階主管、社會工作部門主管、社會工作人員三類，共計分析16份受訪資料。本研究發現，新管理主義對於醫院醫療服務的影響分為兩個層面，其一為醫院管理面向，包含：（1）醫院在財務上有較嚴格的規範、（2）重視病人之需求為導向、（3）實施院內績效管理制度等。第二面向是醫療臨床面向，如：（1）以營收做為醫療服務成果的解讀、（2）以績效獎勵監控醫療專業行為、（3）對於醫療專業自主的限制等。立基上述，本研究提出了弱勢病人就醫面、健康保險制度面及醫院醫療面等具體建議，並提出了對於醫務社會工作的啟示。

The trend and effect of new managerialism have been spread in all fields, and the impact has also changed hospitals' medical services in healthcare, which has even indirectly affected medical social work. This study intends to investigate the effect of new managerialism on hospitals' medical services. This qualitative study adopted stratified purposive sampling. The interviewees were interviewed with individual in-depth interview. This study also intends to concurrently analyze the implication for medical social work. Therefore, 3 types of subjects received the interviews, including directors in hospitals, supervisors of department of social work, and social workers. This study analyzed the data of a total of 16 subjects. This study found that the effect of new managerialism on hospitals' medical services could be divided into 2 aspects. Aspect 1 was hospital management, including (1) the establishment of hospital financial disciplines; (2) the implementation of patients' customer-oriented measures; (3) the application of performance management in hospitals. Aspect 2 was hospital clinical practices, including (1) the interpretation of medical service outcomes using income; (2) the implementation of monitoring and reward and punishment system for professional medical performance; (3) the reduction of professional discretion. Based on the above, this study proposed suggestions for medical seeking of vulnerable patients, health insurance system, and hospital clinical services, as well as proposed the implication for medical social work.

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