Kevin Chien-Chang Wu
Chairperson, Department of Psychiatry, National Taiwan University Hospital
Dissertation Title： "Who Counts? The General and the Particular in Health Care Policy Making"It has been a dilemma to count and balance the general and the particular in health care policy making. This thesis aims to explore this issue by addressing the institutions and epistemic frames in three different domains.
Paper I: Individual Sleep Quality and Neighborhood Perceived Security Individual sleep quality has been an important health care policy problem; however, its relationship to neighborhood collective perception of security has not been well studied. Using a representative sample of 40,000 individuals from a cross-sectional survey in Taiwan, this paper conducted a four-level random intercept multilevel analysis to explore the above relationship. As the percentage of people feeling secure increased, individual sleep quality increased in all groups. However, not all groups of people enjoy the benefit to the same extent.
Paper II: Odyssey of SSRI-induced Suicide: Co-Production of Pharmaceutical Knowledge and Regulatory Culture Whether SSRIs (Selective Serotonin Reuptake Inhibitors) could induce suicidal behaviors has been fiercely debated in the U.S. Using a co-productionist framework, this paper argues that pharmaceutical knowledge (science) and pharmaceutical regulatory culture (society) are co-produced. Fixation on RCTs may make SSRI-induced suicidality inequitably invisible. Adopting a quasi-insurance scheme funded by a defined proportion of pharmaceutical sales, I recommend setting up an independent research fund to sponsor research into rare severe pharmaceutical adverse effects and a no-fault compensation fund to compensate for rare severe pharmaceutical adverse effects.
Paper III: From Standard of Care to Quality of Care: The Epistemic Economy of Appropriate Health Care Political economy of health care has an interactive relationship with institutions and epistemic frames used to construct the appropriateness of health care. In order to show this, this paper addresses two U.S. institutions: (1) medical malpractice litigation with individual-based approach; (2) managed care and evidence-based medicine with population-based approach. It points out the normative implications in choosing epistemic frames. Finally, it argues for maintaining a credible forum to balance the individual-based approach and population-based approach in defining appropriate health care.