中文摘要

根據官方及非營利組織所公佈的資料，國內醫療偏差及犯罪問題日益增多，不僅衍 生重大的經濟損失，更造成人身安全的危害。醫事人員被公認為「專業人士」，專業人 士是社會上享有較高威望的工作者。諷刺的是，社會大眾對於這些專業人士的期待卻受 到了多方面的考驗。事實上，由於過去某些醫事人員把自我利益置於公共利益或民眾福 祉之上，以致醫事人員所慣用的「家長式作風」，逐漸受到挑戰和質疑，社會大眾要求 政府對醫事人員自利行為嚴加管制的呼聲，也愈來愈響亮。 國外文獻顯示，醫療犯罪案件數量龐大、損害嚴重。美國研究估計，每年因健保詐 欺與資源濫用的損失就高達千億美元，約有3%的醫師經常性從事醫療詐欺行為，有更 高比例的醫師涉及曖昧不當的收費。不論損害的真正金額到底為何，健保詐欺確實嚴重 侵蝕醫療資源，剝奪病患原應享有的醫療品質，病患甚至因為非必要的、或有害的措施 而遭受直接傷害。相關研究進一步指出，醫療犯罪的暴力傷害更是驚人，研究人員推估 約15~20%的手術是不必要執行的，全美每年約有16,000 名病患死於不必要執行的手 術。許多非必要手術的執行動機已超越醫療本質的範圍，病患的客觀需求並非是決定手 術執行的最主要因素。有學者甚至明白指出，在專業人士的犯罪行為中，「醫療犯罪」 是最未被研究以及最未被瞭解的一種類型。 醫療犯罪不僅引發醫療糾紛問題，更嚴重損及醫療品質與侵蝕社會資源，實為破壞 社會正義的重大犯罪議題。惟國內犯罪學界針對醫療犯罪的研究至今卻極為缺乏，犯罪 研究者對醫療犯罪現象甚感陌生，相關的系統性科學研究更是付諸闕如，遑論良好防治 政策的建構。顯然，醫療犯罪與被害的本土資料急待填補與累積，醫療犯罪防治對策的 研究實具重要性和急迫性。 醫療犯罪為本土犯罪學研究的新領域，為了對醫療犯罪進行完整且詳盡的透視，進 而建構系統化資料庫與本土化解釋理論，擬定有效的防治對策，本研究期程規劃為三 年。第一年研究目的，在於清楚且完整呈現醫療犯罪現象，建立醫療犯罪與被害的參考 指標。第二年研究目的，在於檢驗醫療犯罪與被害參考指標的信、效度，瞭解國內現行 防治醫療犯罪政策的內容與不足之處，並分析與比較不同國家防治醫療犯罪的政策。第 三年則是建構本土理論、防治對策及長期觀測醫療犯罪的資料庫。 為順利達成前述目的，本研究將採用複合式的資料蒐集法，即資料蒐集自多種來 源，以求客觀及豐富性，研究擬以下列步驟進行。第一年：除作國內、外有關醫療 犯罪之文獻探討外，計畫蒐集三項資料進行內容分析，分別是醫療管制機關的次級資 料、相關案件法院判決書及媒體資料。接著針對醫療管制機關人員及檢調人員、醫療犯 罪者及被害者進行深入訪談，並針對醫療犯罪被害者進行問卷調查，以建構醫療犯罪與 被害的初步參考指標。第二年：分析、比較前一年所蒐集的質化與量化資料，檢驗 參考指標的信、效度。針對醫事人員及醫療管制機關人員進行問卷調查，以瞭解國 內政策的現況與困難，並系統性蒐集和分析不同國家的醫療犯罪防治政策資料。第三 年：將舉辦三次專家學者座談會，檢驗資料蒐集的品質，持續訪談並擴大訪談對象的範 圍，訪談對像包括醫療機構人員、醫療管制機關人員、刑事司法人員、醫療犯罪者及被 害者，訪談內容主要為醫療犯罪的影響因素及防治政策的要件。最後，綜合各種途徑所 蒐集的資料，參考相關研究文獻，歸納出本研究的主要發現與結論。

English Abstract

According to the data revealed by government and non-profit organizations, medical crime and deviance have increased significantly in Taiwan. Medical crime and deviance not only create serious economic cost, but also lead to substantial physical harm. Members of medical profession are recognized as professionals. The medical profession has generally enjoyed great prestige in our society. Ironically, the public expectation of medical professionals has been challenged. Actually, some medical professionals impose self-interest above public interest and welfare, thus, the paternalism they often use upon their clients has been generally challenged and questioned. The public request to government for regulating the self-interest activities of medical professionals has been highly enhanced. Foreign criminological literature reveals that the amount of medical crime and its damage are enormous. Estimates of overall annual losses in the United States due to health care fraud or abuse have ranged as high as 100 billion dollars. Some 3% of the nation』s physicians routinely commit fraud, with a much larger percentage engaging in improper, ambiguous billing. Whatever the actual amount, Medicaid and Medicare fraud clearly drains off medical resources, deprives patients of needed care, and in some cases leads to direct injury of patients through unnecessary and harmful operations. Some studies have suggested that up to 15 to 20 percent of the surgeries performed annually may be unnecessary. Some 16,000 patients die annually in the United States from unnecessary operations. Many unnecessary operations are performed out of an apparently sincere belief in the benefits of the surgery. The objective needs of patients are not the crucial factor for the surgery decision-making. Medical crime is regarded as the least studied and realized professional crime. Medical crime not only engenders medical care dispute but also decreases medical care quality and corrodes social resources. It is a serious criminal issue that destroys social justice. However, the research targeted upon medical crime is highly scant. Local criminologists are not familiar with medical crime. The systematic research concerning medical crime has never been conducted in Taiwan. The control and prevention policy has never been evaluated either. Obviously, the empirical data about medical crime is necessary to be accumulated urgently. The research on public policy of medical crime is also important and urgent. Medical crime is a new field for Taiwan criminological academics. In order to examine as comprehensively as possible the many aspects of medical crime, it will take three years to complete this study. The study purpose of the first year includes realizing the medical crime phenomenon thoroughly and clearly, establishing the preliminary predictors for medical crime and victimization. The study purpose of the second year includes examining reliability and validity of the preliminary predictors, realizing the current control and prevention policy of medical crime in Taiwan, and analyzing and comparing the relevant policies of different countries. The study purpose of the third year includes constructing localized theory, control and prevention policy, data base for long-term supervising medical crime. To accomplish the above purposes, this research will employ a multi-approach to collect data. In the first year, literature related with medical crime will be collected and analyzed. In addition, the secondary data will be collected form regulatory agencies, court and the media. A deliberate interview will be conducted to obtain the data concerning medical crime and victimization. The employees of regulatory agencies and criminal justice agencies, medical criminals and victims will be the targeted interviewees. A questionnaire survey will be also conducted in the first year. A number of medical crime victims will become the representative sample. In the second year, the former collected qualitative and quantitative data will be analyzed and compared. The other questionnaire survey will be conducted to collect data concerning public policy. A number of medical professionals and employees of regulatory agencies will become the representative sample for questionnaire survey. A comprehensive literature relevant with public policy in different countries will be collected and analyzed. In the third year, three seminars consisted of experts and scholars will be hold. The purpose of seminar is to control and examine the quality of the collected data. A more widespread interview will be conducted continuously. Final findings and conclusions will base upon the data collected from the above approaches.  

資料來源：https://goo.gl/iibjHP