• 作者： 張苙雲
• 作者服務機構： 中央研究院民族學研究所
• 中文摘要： 台灣醫療產業過去二十多年的發展走向可以歸納為三個面向：資本挹注源頭的多元化、組織物種之間的競爭和相互消長、和三度空間的資源分佈型態。本文以和既有文獻對話的方式，對台灣醫療產業的發展所突顯出來的意涵、成因、和衍生的議題，檢討幾個組織變遷理論上有關組織策略的選擇和變遷形式、產業競爭氣候的形成、以及組織機會結構的建構和再製等議題。本文指出（1）組織變遷的研究僅討論組織的出生與死亡是有所不足的。以台灣醫療產業的變遷形式來看，轉型和結盟的發生在產業變遷的原動力和變遷發展之軌跡上有其特殊意涵。產業中的組織並非相互獨立、互不來往的實體。組織間的往來雖不盡然會發展成命運與共的緊密連結，但至少利益上的交互重疊是免不了；（2)文獻中組織因「結構慣性」，侷限了因應迴旋外在環境挑戰的能力，故而求變不易。然觀察台灣醫療組織的變遷的發生率呈J字型，有愈來愈多的趨勢，指出產業生態的變化固然有其自然週期，但是制度環境的強力介入，是足以阻礙、扭曲、甚或改造產業生態的自然發展；（3）產業中競爭氣候固然是與產業整體持續性發展有關，但產業競爭氣候的激化卻是外部的，是外在環境誘發的。外在制度環境和組織在產業中的體質和地位互動，而形成且再製組織差異機會結構，可能更為關鍵。（4)無論是轉型或是結盟，組織變遷的著眼點都是外衍的，是著眼於市場競爭，而非內省的，非以組織內部的目標和效率為導向。所以；（5）組織生態環境的變化應被視為既有產業階層結構與國家和相關組織之政策相互影響下之產物。由這樣的分析很清楚的看到權力這個面向的重要性，本文指出這個權力重整和再分配的過程正是組織變遷研究之核心所在。
• 英文摘要： Our previous study indicates that the Taiwan health industry is characterized by three features: capitalpluralization, keen competition among different forms of health organizations, and a three dimensionaldistribution of health resources. Two questions are addressed in this paper: 1) How is the health industrystructured? 2) What are the sources of organizational change in the Taiwan health industry? We find thatthe incidence of organizational transformation and coalition in the Taiwan health industry has increasedat a faster rate in recent years. Hospitals and clinics link each other to form symbiotic associations inorder to expand their share of such markets as capital, patients, and health manpower. Internal organi-zational efficiency is not a major aim of the actions they have taken to meet challenges from the externalenvironment. This study again indicates the importance of institutional forces on the formation of industrystructures, in the sense that such institutional forces reinforce the opportunity structure among organi-zations in the industry. Differential opportunity structures among organizations, along with the eicpansionof the health industry in recent years, have brought about the mode of competition for scarce resources,and organizations wish to further enhance and upgrade their status in the market. The current ecology ofthe health industry is considered to be a consequence of the interaction between the previous state of thehealth industry and health policies. The concept of power is included as a basic reference to the process oforganizational change in the Taiwan health industry.
• 中文關鍵字： 車輛持有; 擴散; 羅吉斯特模式
• 英文關鍵字： --