醫療財團法人之防貪監督機制—以非營利與營利組織間之界線為核心

Abstract

我國醫療法第46條規定，醫療財團法人之年度醫療收入盈餘，至少應有百分之二十以上用於醫療研究發展以及社會服務事項，可知其係為一非營利組織，盈餘使用應以公益及醫療服務目的為限，不得有圖利私人之行為發生。然而，近年來，許多大型醫療財團法人卻接連爆發財報黑幕與關係人交易等利益輸送疑慮。對此般掌控龐大醫療資源，並具廣泛社會影響力的醫療財團法人，現行法上，卻始終缺乏相應密度的法規予以制衡，主管機關之外部監督亦有失能之虞。 外部監督機制的不足，亦將弱化內部監督機制的自律誘因。公益性的非營利組織極可能會淪為關係人生財之工具，醫療貪腐問題相應而生。醫療財團法人防貪監督機制若無法發揮效能，其所造成的影響層面，除了醫療資源的浪費，更可能導致醫療服務品質的降低，進而危害病患安全與我國公民之健康。 是故，本文首先將探討醫療財團法人之本質，試對醫療財團法人進行法律上定位。其次，本文將針對我國醫療財團法人之貪腐問題，分析其內外部監督機制是否能有效防止弊端；並藉由研究醫療財團法人貪腐犯罪之刑事判決內容，以及訪談醫療實務領域人士，對現況下之貪瀆不法行為與防貪監督機制之運作進行實證研究。本文亦將輔以比較美國非營利醫療機構之治理實務與法規概況，希冀能對我國醫療財團法人防貪監督機制之建立，提出未來之立法建議。

According to Article 46 of Medical Care Act, medical care corporate shall allot at least twenty percent of the annual medical care income for medical research and development as well as community services. As a nonprofit organization, medical care corporate is committed to serving the public benefit, and its net earning shall not inure to the benefit of any individual. Recently, however, many medical care corporates were involved in fraudulent financial reporting, improper self-dealing and related party transactions scandals. The core issue remains that medical care corporates possess large amounts of medical resources and tremendous social impact, yet the government takes a comparatively loose regulatory approach. The corruption in healthcare sector results in medical waste, affecting the performance of the healthcare system and the quality of medical care. Without establishing an effective external supervision mechanism, the incentives for medical care corporates to exert self-control would certainly be reduced. Consequently, nonprofit organization may operate for the benefit of related parties and against public interest. By comparing the governance of nonprofit healthcare organizations in the United States, this thesis aims to analyze the legal nature of medical care corporate, and the effectiveness of internal and external supervision mechanisms to prevent corruption in medical care corporates. Moreover, in order to integrate practice with theory, this thesis also conducts empirical research by interviewing professionals in the healthcare industry and studying healthcare corruption related cases to examine the corruption issues in medical care corporates more comprehensively. Through the research in theory and in practice, this thesis would like to provide useful and practical suggestions for future law amending to establish sound anti-corruption supervision mechanism in medical care corporates.