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研究生:陳怡伶
研究生(外文):I Ling Chen
論文名稱:社會主義轉型下的越南醫療體系變革
論文名稱(外文):On the Change of Healthcare System by a Transforming Socialist State in Vietnam
指導教授:白裕彬白裕彬引用關係
指導教授(外文):Y. B. Bai
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:86
中文關鍵詞:越南醫療體系改革社會主義轉型
外文關鍵詞:VietnamHealthcare reformSocialist transformation
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自南北越統一後,在面臨世界經濟自由化的發展趨勢之下,越南政府在1986年實行了開放性的革新政策,以「去管制」的方式解除國家對私營經濟體的限制,近年來更不斷積極鼓勵外資投入越南國內包括醫療產業等各產業市場。越南在原有社會主義的計劃經濟受到資本主義引入的衝擊之下,經濟體的轉型也促進私營體系進入越南的醫療市場,政府為了因應新興的醫療市場模式,自1989年開始為越南的醫療體系進行一連串的醫療改革。
在這一連串醫療改革中,越南政府首要先改變了越南醫療體系中財物籌措的方式;並解除了對私營機構的管制,改變原有單一公有體系的經營管理模式,造就現有公私合併的醫療體系。此外,在1992年越南政府更藉由健康保險的推行,以達到醫療費用的風險分攤效果與醫療財務負擔的公平性。
然而研究發現越南近年的醫療改革不論是在開放私營醫療機構或是推行健康保險的政策效果都不彰顯,私營醫療層級至今多停留在小型的醫療診所、藥房等,私營的醫院至2004年仍僅占國內總醫院數的3.5%;而國內健康保險覆蓋率仍僅占49%的人口;而現今越南的醫藥市場也仍由國家握有較大的權益與優勢。
本研究利用文獻分析法統整分析越南近年醫療改革政策的意涵與成效;並同時以深度訪談法訪問在台之越籍人士,詢問在醫療改革政策之下越南民眾的就醫情形與對國內醫療體系之觀點等相關經驗。
Since the integration of Vietnam, confronting the trend of economic liberalization in the whole world, in 1986, the government launched a political and economic renewal campaign─Doi Moi intended to facilitate the transition from a centralized economy to a market economy. The government has planned the market to privatization and deregulated the private enterprises. In the recent years the government has been actively encouraging foreign firms to invest and operate there, include the health care industry. By the impact of the introduction of capitalism, the transformation also developed the private medical practice to enter the health market. Since 1989, the government launches the health care reform to response to the emerging model of health care system in Vietnam.
The main of the health care reforms is changing the financing by the introduction of user charges at public health facilities, and achieving the public-private mix system by legalizing these private medical establishments. And, in 1992, the Vietnamese Government promoted the health insurance into the universal hope to achieve the fair of financial contribution and sharing the risk of medical expenses.
However, many researches has found whether the privatization of health care system or the implementation of health insurance didn’t achieve remarkable success, the private medical establishments usually are small medical clinics, pharmacies and so on, in 2004 the private hospital was only 3.5%, and the national health insurance coverage was 49%. Furthermore, the country still holds the rights and advantages in the pharmaceutical market in Vietnam.
In this study, by Document Analysis to analyzing the policies of health care reform in recent years, the meaning of policies, and the effectiveness of these projects. And by interviewing the Vietnamese to know how the Vietnamese’s medical situation is and their viewpoints under these reform policies.
目 錄
第一章 緒 論 1
第一節 研究動機 1
第二節 研究背景 3
第三節 研究目的 9
第二章 研究方法及步驟 10
第一節 研究方法 10
第二節 研究架構 14
第三章 文獻探討 15
第一節 越南政經環境與經貿自由化發展 15
第二節 越南之醫療體系 24
第四章 研究結果與討論 36
第一節 越南醫療改革之政策 36
第二節 醫療改革政策與財務預算 40
第三節 公、私合併的醫療體系 47
第四節 越南健康保險的演進 55
第五節 越南製藥市場的發展 62
第六節 研究討論小結 65
第五章 結論與建議 68
第一節 結論 68
第二節 研究貢獻與未來研究建議 71
第三節 研究限制 72
參考文獻 73

表目錄

表1-1. 1988–2008年台灣在越南投資統計 2
表2-1. 訪談大綱 12
表2-2. 訪談對象記錄表 13
表3-1. 1988–2008年各國在越南投資統計 20
表4-1. 1989–1999年間,越南衛生相關政策改革年表 38
表4-2. 1991–2002年間,越南人口、GDP與衛生總預算比例 43
表4-3. 越南總醫院數與總病床數之歷年數據 49

圖目錄

圖1-1. 1990–2008年越南國內生產毛額與平均個人GDP 6
圖1-2. 貧窮人口分布密度與各省之貧窮率比 8
圖3-1. 醫療改革前越南醫療體系架構 25
圖3-2. 越南民眾就醫之醫療利用比例 28
圖3-3. 越南現有醫療組織架構圖 30
圖3-4. 1986–2007年越南全國之醫事人力 35
圖4-1. 醫療總支出之資金來源百分比 41
圖4-2. 各國國家與私人醫療支出比例 42
圖4-3. 1991–2002年,越南中央與地方政府醫療支出百分比 44
圖4-4. 1993–2002年,越南政府NTPs支出佔醫療預算百分比 45
圖4-5. 2001下半年–2007上半年,越南國內消費者物價指數 46
圖4-6. 1986–2006年,越南國內每萬人平均之病床數 50
圖4-7. 各級所得之民眾各項醫療服務費用占醫療總費用比例
英文文獻
Pascale Brudon Health Care Financing for Viet Nam, United Nations,Hanoi , 2003。
Björn Ekman, Nguyen Thanh Liem, Ha Anh Duc and Henrik Axelson. “Health insurance reform in Vietnam: a review of recent developments and future challenges”, Health Policy Plan, 23(4), pp. 252-263, 2008.
Matthew Jowett. "Theoretical Insights into the Development of Health Insurance in Low-Income Countries", The University of York, York, 2004.
Matthew Jowett, Robin Thompson. "Paying for Health Care in Vietnam: Extending Voluntary Health Insurance Coverage", The University of York, York, 1999.
Nicholas Minot, Bob Baulch, and Michael Epprecht. "Poverty and Inequality in Vietnam: Spatial Patterns and Geographic Determinants", International Food Policy Research Institute and Institute of Development Studies, Washington D.C., 2003.
William Newbrander. "Private Health Sector Growth in Asia: Issues and Implications", John Wiley & Sons Ltd, Canada, 1997.
Nguyen Duy Khe, Pham Huy Dung, Ho Dang Phuc, Hoang Van Minh, Nguyen Xuan Thanh, Bo Eriksson, Vinod Diwan, and Nguyen Thi Kim Chuc. "Health and Health Care: Equity Aspects in FilaBavi, Vietnam", Measuring Health Equity in Small Areas – Findings from Demographic Surveillance Systems, Indepth Network, 2005.
Nguyen Phuong Do, "Issues of Equity and Effectiveness in Health Care in Vietnam", In Efficient, Equity-Oriented Strategies for Health International Perspectives-Focus on Vietnam, CIMH Melbourne, pp.15-26, 2000.
Nguyen Thi Hong Ha, Peter Berman and Ulla Larsen. "Household Utilization and Expenditure on Private and Public Health Services in Vietnam", Health Policy Plan, 17(1) , pp.61-70, 2002.
Natasha Palmer, Anne Mills, Haroon Wadee, Lucy Gilson, and Helen Schneider. "A New Face for Private Providers in Developing Countries: What Implications for Public Health", Bulletin of the World Health Organization, 80, pp. 292-297, 2002。
Pham Huy Dung. "The Political Process and the Private Health Sector's Role in Vietnam", International Journal of Health Planning and Management, 11, pp. 217-230, 1996.
Phuong Nguyen Thi Kim, Afsar Akal. "Recent Advances in Social Health Insurance in Vietnam", World Health Organization. 2003.
Gareth Porter. Vietnam: the politics of bureaucratic socialism , Cornell University Press, New York, 1993.
Ardeshir Sepehri, Robert Chernomas, Haroon Akram-Lodhi. " If They Get Sick, They Are in Trouble: Health Care Restructuring, User Charges, and Equity in Vietnam" International Journal of Health Services, 33(11), pp.137-161,2003.
Ardeshir Sepehri, Robert Chernomas, Haroon Akram-Lodhi. "Penalizing patients and rewarding providers: user charges and health care utilization in Vietnam" , Health Policy and Planning, 20(2), pp.90-99, 2005.
The Socialist Republic of Vietnam, The World Bank. Vietnam Public Expenditure Review and Integrated Fiduciary Assessment-Volume: 1, Financial Publishing House, Hanoi, 2005.
       . Vietnam Public Expenditure Review and Integrated Fiduciary Assessment-Volume: 2, Financial Publishing House, Hanoi, 2005.
Tran Tuan. "Community-based Evidence about the Health Care System in Rural Vietnam" The University of Newcastle, Australia, 2004.
Vietnam Ministry of Health. Health Statistics Yearbook 2006, Medical Publishing House-Hanoi, Hanoi, 2006.
    . Hospital System of Vietnam-an Overview, Medical Publishing House-Hanoi, Hanoi, 2005.
The World Bank, Sida, AusAID. "Vietnam:Growing Healthy- a Review of Vietnam's Health Sector", The World Bank, 2005.
The World Bank. Little Data Book 2006, The World Bank, 2006.
       . Little Green Data Book 2006, The World Bank, 2006.

中文文獻
于向東,譚志詞,《越南:革新進程中日漸崛起》,香港,香港城市大學出版社,2005。
吳士存,朱華友,《越南、馬來西亞、菲律賓、印度尼西亞、汶萊 五國經濟研究》,北京,世界知識出版社,2006。
宋鎮照,《建構台灣與東南亞新世紀關係─南向發展之政經社場域策略分析》,台北,海峽學術出版社,2006。
   ,《東協國家之政經發展》,台北,五南出版社,1996。
林佾靜,〈越南國營企業改革: 回顧與檢視〉,國立政治大學外交所,博士論文,2005。
徐紹麗,利國,張訓常,《越南》,北京,社會科學文獻出版社,2005。
阮文和,〈越南公立醫院品質實務與績效的關係之探討〉,國立高雄應用科技大學商務經營研究所,碩士論文,2006。
馮氏惠,〈越南行政手續改革探索〉,越南社會科學院中國研究院,2005。
顧長永,《東南亞政治學》,台北,巨流圖書公司,2005。
   ,《越南:巨變的二十年》,台北,台灣商務印書館,2007。
薩德賽(D.R.SarDesai)著,《東南亞史(下)》,蔡百詮譯,台北,麥田出版社,2001。
網站資訊
General Statistics Office of Vietnam, http://www.gso.gov.vn/default_en.aspx?tabid=471&idmid=3 2008/12/26
General Statistics Office of Vietnam, http://www.gso.gov.vn/default_en.aspx?tabid=494&itemid=1595&idmid=1 2008/12/26
General Statistics Office of Vietnam, http://www.gso.gov.vn/default_en.aspx?tabid=467&idmid=3 2008/12/26
International Monetary Fund(IMF), http://www.imf.org/external/data.htm#data 2008/12/27v
Ministry of Planning and Investment(越南投資計畫部)http://www.mpi.gov.vn/portal/page/portal/mpi_en 2008/12/30
WHO Statistical Information System http://www.who.int/whosis/database 2008/04/06
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