Chiu Yu-Chan, Smith Katherine Clegg, Morlock Laura, Wissow Lawrence
Chang Gung University, Health Care Management, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
Soc Sci Med. 2007 Feb;64(3):521-30. doi: 10.1016/j.socscimed.2006.09.018. Epub 2006 Oct 30.
The Taiwanese practice of patients giving informal payments to physicians to secure services is deeply rooted in social and cultural factors. This study examines the portrayal of informal payments by Taiwanese print news media over a period of 12 years-from prior to until after the implementation of national health insurance (NHI) in Taiwan in 1995. The goal of the study was to examine how the advent of NHI changed the rationale for and use of informal payments. Both before and after the introduction of NHI, Taiwanese newspapers portrayed informal payments as appropriate means to secure access to better health care. Newspaper accounts established that, although NHI reduced patients' financial barriers to care, it did not change deeply held cultural beliefs that good care depended on the development of a reciprocal sense of obligation between patients and physicians. Physicians may have also encouraged the ongoing use of informal payments to make up revenue lost when NHI standardized fees and limited income from dispensing medications. In 2002, seven years after the implementation of NHI, the use of informal payments, though illegal, was still being justified in the print media through allusions to its role in traditional Taiwanese culture.
台湾患者向医生支付非正式费用以获取服务的做法深深植根于社会和文化因素。本研究考察了台湾平面新闻媒体在12年期间（从1995年台湾实施全民健康保险[NHI]之前到之后）对非正式支付的描述。该研究的目的是考察NHI的出现如何改变了非正式支付的理由和使用情况。在引入NHI之前和之后，台湾报纸都将非正式支付描绘为确保获得更好医疗保健的适当手段。报纸报道表明，尽管NHI降低了患者获得医疗服务的经济障碍，但它并没有改变根深蒂固的文化观念，即优质医疗依赖于患者与医生之间互惠义务感的建立。医生可能也鼓励继续使用非正式支付来弥补NHI使费用标准化并限制药品配给收入后损失的收入。2002年，即NHI实施七年后，非正式支付的使用虽然是非法的，但仍在平面媒体中通过提及它在传统台湾文化中的作用而被合理化。
