背景:自2006年以来,台湾积极发展医疗旅游业。2013年,政府试图通过将医疗旅游纳入自由经济试验区来加强这一部门。尽管勉强错过了标记,该倡议未能成为法律。这项定性研究致力于辨别影响将医疗旅游纳入台湾自由经济试验区的议程设定过程的相关因素。
方法:通过半结构化访谈和对政策文件的全面审查,对自由经济试验区内医疗旅游合法化的政策进行了全面审查。使用目的性和雪球采样技术战略性地选择关键线人。主题分析用于仔细检查所收集的数据,并在Kingdon的多个流的框架内进行组织。
结果:在问题流中,在国家健康保险计划下,不断增加的财务压力和成本控制压力长期以来一直驱使医疗保健提供者在医疗旅游中寻求进一步的机会。台湾扩大医疗旅游的现有障碍包括外交紧张(特别是两岸关系),公众对医疗商业化的担忧,减少了他们获得医疗服务的机会,法律和语言障碍。在政策流中,支持国民健康保险的特许经营费等因素,允许的示范医疗旅游景点和服务数量有限,外国医务人员的津贴,管理家庭医生的法规,示范的重要性,regulation,和认证,以及对中国投资的限制,被强调了。政治流突出了政府支持等因素,反对党的反对,来自学术界和非政府组织的公众关注和批评,和医学院的怀疑。
结论:承认在颁布《自由经济试验区特别法》的医疗旅游条款方面面临的公认挑战,并强调领导层的政治意愿,可行的政策解决方案仍然难以捉摸。尽管存在通过该法案的机会之窗,随着公众的担忧将这一问题从国家议程中排除,这一情况有所减弱。台湾案件强调了对问题进行细致考虑的必要性,提出的解决方案,和政治动态,以实现成功的政策制定。
BACKGROUND: Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan.
METHODS: A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon\'s multiple streams.
RESULTS: In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties.
CONCLUSIONS: Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.