9卷3期

• Link 綜論 Review Article
• 政治意識型態與健康人權Political Ideologies and the Rights to Health Care
• 李卓倫
  Jwo-Leun Lee
• 無
  Health Care System ; Social Perception ; Health Policy
• 本文旨在分析自由主義、保守主義和社會主義三種意識型態對「健康人權」概念的衝擊，討論內容偏重各種意識型態對「如何分配」和「政府角色」的主張。古典自由主義對資本主義的合理化使它的使康人權概念容易化約為市場上的買賣關係，近代自由主義則論證了公平分配財富的必要性，為福利社會中的健康照護權利作了相當程度的合理化。保守主義往往反對過多的政府干預而減低個人追求健康的責任，具有實用主義色彩的新保守主義在面對控制健康照護成本的迫切需要時比較容易忽略公平層面的考慮。社會主義依據「各盡所能，各取所需」的理念對使康人權問題提出相當的關切，並大聲疾呼人民接受健康照護的權利和政府提供健康照護的責任。本文透過各種意識型態中「人性觀」與「社會觀」的辨證，期能對有關「健康人權」的思考方式演變提供貢獻。
  This paper reviews the concept of the rights to health care under three political ideologies--the liberalism, conservatism and socialism--dominantly by disscussing the problems of distribution and the role of government. The ideas of classical liberalism, which rationalize capitalism, reduce the rights to health care to a kind of trading. By justifying the fair sharing of social wealth, recent liberalism makes some contributions to the rationalization of the right to health care in a welfare society. Conservatism emphasizes the constraints on political power to affect change and the virtues of public restraint in dealing with many health problems. A particular danger of conservatism is that the goal of equity in health care delivery may be abandoned or lessened in priority in the face of the exigencies for health care cost containment. Socialism legitimatizes the concept of health right by following the concept of ”from each according to his ability; to each according to his need”. Socialism claims the people's right to health care and the governmental responsibility of providing a comprehensive health care system. Through the conceptual debate of humanity and society in varied ideologies, this paper expects to contribute to the reform thinking process about health care rights.
• 113 - 122
• 10.6288/JNPHARC1989-09-03-01

• Link 綜論 Review Article
• 健康信念模式的回顧與前瞻Retrocpect and Procpect of Health Belief Model
• 李守義、周碧瑟、晏涵文
  Shoou-Yih Lee, Pesus Chou, Edwin H. Yen
• 無
  Health Behavior
• 健康信念模式在1950年代被提出用以解釋民眾之健康行為以來，一直受到醫療社會學者普遍的重視，除了預防性行為之外，它也被運用於疾病行為、病人角色行為、醫病關係、以及衛生教育介入等研究領域之中。 Berker等人和Janz曾分別比較1974年之前，以及1974-1984年間的健康信念模式研究，發覺此模式在解釋民眾之健康行為，尤其是預防性健康行為方面，相當的適用。本文參考上述學者之比較方法，接著回顧1984至1987數年間，發表於國內外期刊的十四篇健康信念棋式研究報告，加以綜合分析，並與1984年以前的研究相互比較，希望籍此了解： 一、近幾年來健康信念模式之研究成果與趨勢； 二、健康信念模式對不同健康行為之解釋和預測能力；以及 三、健康信念模式在不同文化環境中的適應性。 此外，文中也討論健康信念模式的限制，以及未來研究應有的取向，期望有助於提升這方面研究之品質。
  Health Belief Model (HBM) has been one of the most famous and popular behavioral models in medical sociology since it was propsed to explain people's health behavior in the 1950's. Not only was it frequently used in preventive behavior research, but also in the study of illness behavior, sick-role behavir, patient-doctor relationship, and health educational intervention. Becker et al. and Janz reviewed the HBM research papers published before 1974 and those from 1974 to 1984 respectively, and they found that this model was very effective in the explanation of people's health behavior, especially the actions taken to prevent illness. In this report we adopted Becker's and Janz's methods to sum marize the findings of fourteen HBM studies in several Chinese and English journals from 1984 to 1987, and compared them with the research results before 1984, so as to understand: 1. the investigation findings and tendency of HBM study in these few years, 2. the efectiveness of HBM in explaining and predicting various kinds of health behaviors, and 3. the validity of HBM in different cultural environments. Also, the limitations and the recent interests in HBM study were discussed in this report. We hope that the analysis and comparison we make in this report may be of some help for related studies in the future. Department of Medical Research, Verterans General Hospital, Taipei, Taiwan, R.O.C.
• 123 - 137
• 10.6288/JNPHARC1989-09-03-02

• Link 原著 Original Article
• 台灣地區1946-86年家庭與社會機構間病人、幼兒與老人照顧責任的相互轉移The Shift of Health Care Responsibilities between the Family and Social Institutions in Taiwan, 1946-86
• 季瑋珠、楊志良
  Wei-Chu Chie, Chih-Liang Yaung
• 無
  Patient Care ; Child Care ; Homes for the Aged ; Health Care Systems
• 本研究以貳次資料分析法，探討了政府出版品統計資料中，台灣自光復以來，「病人、幼兒與老人照顧」工作在「家庭」與「社會機構」之間相互轉移的長期趨勢。本研究的「健康照顧」包含了：1.（住院）病人照顧，以每萬人口病?數為指標，2.幼兒照顧，以每萬適齡幼兒幼稚園數及適齡幼兒就學率為指標，3.老人（安養）照顧，以每十萬老年人口安養院數及每千老年人口受安養數為指標。結果發現「住院病人照顧」及「幼兒照顧」，均自民國60年代起，出現明顯的「社會機構取代家庭」的現象，「老人照顧」則不但無此現象，其取代程度反而自民國47-50年的高?後便漸漸下際，60年代初期下降最快。本研究討論了可能的原因，預測了未來的趨勢，並作政策上的建議。
  In this study, secondary analysis was performed to investigate the shift of health care responsibilities between the family and social institution in Taiwan since 1946 to 1986, based on the official statistics. The index of ”health care” in the study included: 1. Acute patient care: acute beds per 10,000 population, 2. Preschool child care: kindergartens per 10,000 preschoolers of proper ages, and percentage of these children attending kindergartens, 3. Care of the aged people: institutions per 100,000 people above 65, and the institution rate of them. The result showed that there were prominent shifts from the family to social institutions since 1970s in Taiwan in the category of acute patient care and preschool child care, while in the care of aged people, the shift was at first increased in 1950s and decreased, especially in the early 1970s. The possible reason the future trends and the limitations of this study were discussed, and some suggestions was proposed to the health policy makers.
• 138 - 146
• 10.6288/JNPHARC1989-09-03-03

• Link 原著 Original Article
• 台灣山地鄕死亡型態與趨勢分析Mortality Patterns and Trends in Taiwan Aborigional Areas
• 胡幼慧、張苙雲、 張玨
  Yow-Hwey Hu, Li-Yuen Chang, Chueh Chang
• 無
  Mortality ; Aborigine
• 本研究旨在探討近十二年（民63-74年）來台灣地區30個山地鄉人口的死亡型態及趨勢。根據省衛生處的死亡資料所進行之全死亡及病因別死亡率分析結果發現：山地鄉男性之年齡標準化死亡率並未下降，特別是生產年齡層(15-44)之男性人口，其死亡率反而嚴重上昇，形成一高?。由十大死因之分析顯示出山地鄉傳染及非傳染性疾病死亡之共現，其中與人為因素有關之死因死亡率（如自殺、肝硬化）已遠超過台灣地區之死亡率，特別是生產年齡層男性人口在這些死因之死亡風險高達台灣地區同齡男性人口之八倍左右。以上發現顯示山地鄉人口已面臨與日俱增之健康危機及連帶社會問題，而目前政府在山地鄉投入的醫療服務之努力本身已無法足夠應付其文化社會變遷所導致之健康危害。
  The purpose of this study is to assess recent (1974-1985) mortality patterns and trends in Taiwan aborigional areas. Based on mortality registration data, mortality due to all causes and specific causes are analyzed. The results indicate that regardless of the improvement in medical services provided by the government, age-adjusted death rates for males in these areas are still increasing, especially among productive ages (15-44). The major causes of death are characterized by the concurrance of high rates of infectious and degenerative/manmade causes of death. For example, death rates for TB, suicide, and liver cirrhosis among young aborigional males are 8 times those of young males in the entire Taiwan area. These results suggest that health and related social problems are not improving, and that these problemes are more associated with wider social-cultural changes than with narrowly-defined medical issues.
• 147 - 161
• 10.6288/JNPHARC1989-09-03-04

• Link 原著 Original Article
• 醫院藥師的工作滿足感：台北市四家一級教學醫院之比較Job Satisfaction among Hospital Pharmacists: Comparision of Four Teaching Hospitals in Taipei
• 林建輝、黃文鴻
  Jainn-Huei Lin, Weng F. Huang
• 無
  Pharmacists ; Job satisfaction
• 本研究係整理與歸納國內外有關工作滿足感之重要研究及理論，進而探討國外有關醫院藥師工作滿足感之研究；繼之實證研究國內醫院藥師工作滿足程度，並比較不同醫院藥師工作滿足感之差異。 本研究利用問卷調查訪視台北市四家一級教學醫院藥師266名。回收率86.8%，有效問卷231份。利用變異數分析(ANOVA0相關(Correlation)，t-test等統計方法探討及比較不同醫院藥師的工作滿足感程度。結果發現國內四家教學醫院藥師的工作滿足程度除了昇遷機會外，在工作本身、工作伙伴、薪水待遇、直屬主管等構面的滿足程度皆高於50%，但值得重視的是對工作本身的滿足程度較薪水待遇方面的滿足低，與其他行業不同。不同醫院的藥師其工作滿足有明顯的差別，公立較私立醫院的工作滿足高，其原因及影響因素值得進一步探討。
  This study was intended to survey the job satisfaction level of pharmacists in medical institutions, and to compare the difference(s) in and correlates of job satisfaction of pharmacists among the surveyed hospitals. A questicnnaire survey containing 72 questions was sent to 266 pharmacists from four major teaching hospitals in Taipei. Valid questionnaire were returned by 231, representing valid a 86.6% effective response rate. Statistical analysis including ANOVA, correlation, and t-test were performed to compare the differences in job satisfaction among pharmacists in different hospital settings. Results of the survey indicate thet 50% of the variance in job satisfaction was explained by four variables: Work itself, Working partners, Salary, Direct Supervisor. Ilt was found the level of satisfaction from the Work Itself is lower than that of Salary, which is different from findings in other studies. Hospital pharmacists in these four teaching hospitals did express significantly different average levels of job satisfaction, and job satisfaction levels among public hospital pharmacists is higher than their colleagues in private hospitals. Reasons of these observations remains to be studied.
• 162 - 167
• 10.6288/JNPHARC1989-09-03-05