You, Su-Fen (2003) Health, policy and medicalisation : a case study of Taiwan's health care reforms. PhD thesis, University of Warwick.

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Abstract

This thesis charts the rising importance of the state in extending the influence of
modern medicine, contexualised within the history and political-economic dynamics
of the health care reforms in Taiwan, a leading Newly Industrialised Country (NIC)
which has a distinguished record of health improvement. It highlights the processes
by which health care reforms represented a shift towards medicalisation, particularly
as consolidated by the creation of a universal National Health Insurance (NHI) system
in 1995. The thesis seeks to analyse these processes by bridging the gap between
medical sociology and health policy evaluation. It deploys a range of methods:
historical analysis of secondary sources and multiple methods of data collection.
These include qualitative in-depth interviews with key actors, a questionnaire survey
and relevant policy documents.
This thesis employs an overarching framework for analysis, which embraces both
the 'political economy' and the 'cultural critique' approaches to health, in ways which
seek to integrate discussion of policy issues and developments at the macro, meso,
and micro-levels. It starts by locating the NHI reform against longer-term historical
processes of modernisation, often as a result of outside influences, and the associated
transformation of medical paradigms that occurred in different periods. It charts how
particular structural factors have impinged on medicine to enable it to become dominant collegiate profession, with special reference to the role of the state promoting the legitimation of particular modes of medical intervention. The thesis
highlights the fact that the NHI has extended the influence of doctors, paradoxically also provides the basis by which medical autonomy has been
undermined. On the other hand, it charts the social impacts of modern medical care,
and argues that the NHI has played an important role in stimulating the process medicalisation and consequently fostered a culture of dependency and passivity
contained in medical technology and in the healing relationship.
This thesis is a reminder that the contemporary Taiwanese health care state is
arriving at a moment of crisis, and that deep reflection on the strengths and
weaknesses of the NHI reform is necessary in order to deal with problems associated
with growing medicalisation, public demands for greater social equity, and new
threats to health, the latest being SARS.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Medical policy -- Taiwan, Health care reform -- Taiwan, Health insurance -- Taiwan
Official Date:	July 2003
Dates:	Date Event July 2003 Submitted
Institution:	University of Warwick
Theses Department:	School of Health and Social Studies
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Carpenter, Mick
Sponsors:	University of Warwick ; Ministry of Education, Republic of China (Taiwan) ; Universities UK ; Chiang Ching-kuo Foundation for International Scholarly Exchange
Extent:	viii, 338 leaves
Language:	eng

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