以國際比較檢視我國醫師團體在執業管制中之定位與功能

Abstract

醫療保險與服務是維護個人生存，增進民族健康，保障國民基本權之重要國家任務。而除了藥品、醫材、設備、醫院外，接受專業訓練、符合專業知識、技術與道德要求的醫療專業人員，包括醫師，也是醫療系統中不可或缺的要角。但相較之下，關於我國醫師團體在醫療行政法制中的角色尚缺乏完整論述，而本文即在檢視我國醫師團體(包括職業團體與學術團體)在執業管制中的定位與功能。\n 為了突顯我國醫師團體的特殊性，考量大陸法/英美法、醫療保險體系、醫療水準、與歷史社會等因素，本文選擇了德國、日本、美國、英國與中國大陸作為參照對比。從「醫療服務與醫療行政系統」到「醫師團體發展歷史與現況」，由大縮小、鑑古知今，將各國家地區之醫師團體的背景事實先做系統化整理、分析、並比較，以理解其在各自國家社會體系中的定位。另外，就其在醫師職業管制中管「入」的「執業資格授予」與管「出」的「執業資格廢止」的作用亦做系統化整理、分析、與比較，以認識各該團體在其中的功能。\n 基於以上的背景事實，再以「公私協力」與「職業自律」深入檢視，我國醫師團體(特別是職業團體之醫師公會) 在醫師職業管制中與國家政府之相對關係和定位，與其在執業資格授予與廢止作用上的功能。\n 關於我國醫師公會在執業管制法制中地位與功能的調整，本文建議：相較於仿德國例全面肯認醫師公會為「公法人」與政府分工，或仿日美英例鬆綁醫師公會為真正的「私法人」與政府制衡，依我國現實條件可由立法者直接立法或授權行政機關以授權命令賦予醫師公會行政受託人地位，並對稱移轉關於醫師執業資格授予與廢止之特定具體權限給公會，則在此委託範圍內公會即可被視為行政機關，即可對應要求其內部章程、組織、與程序須符合行政法法規與法理。

Medical insurance and services are national tasks essentially for maintaining personal survival, improving people health, and protecting fundamental civil rights. Along with medicines, medical materials, equipment, and hospitals, medical professionals, including physicians, who have received professional training and met the requirements of expertise, technology and ethics, are indispensable for a working medical system. However, discussions about the roles of physician groups in medical administrative law systems in Taiwan are few. Thus, the present work is to examine positions and functions of physicians groups (including professional groups and academic groups) in the medical practicing regulation in Taiwan.\n In order to highlight the particularities of Taiwan physician groups and to take account of the differences in the continental law/Common law, medical insurance systems, medical service levels, and historical and social factors, Germany, Japan, the United States and the United Kingdom were selected for reference and comparison. From the "medical service and medical administrative systems" to "development history and present situation of the groups", the background facts of representative physicians groups were systematically collected, analyzed, and compared for comprehension of their positions in the social systems in their respective countries. Besides, regulatory functions of the groups in approving and revoking medical practicing qualifications were also systematically collected, analyzed, and compared for acknowledgement. \n Based on the above background facts and the concepts of "public-private partnership" and "professional autonomy", we further inspected Taiwan physician groups, especially the professional groups of physicians, to review their relationship with the government in professional regulation, and functions in practicing licensure. \n Regarding the positions and functions of the professional groups of physicians in medical practicing regulation in Taiwan, the following adjustment is proposed: Rather than adopting the “public legal entity” model for fulfilling national duties as in Germany, or “fully private corporation” model for balancing national regulation as in Japan, the United States, and the United Kingdom, our legislatives and administrative authorities could authorize by law the professional groups of physicians to exercise the powers specifically for medical practicing licensure, and thus the groups, as commissioned administrative agencies, should be required to amend their own bylaws, organizations, and procedures about the above authorized areas in concordance with administrative laws.