In this study, the concept of &lsquo / Social Market Economy&rsquo / which was the leading idea in the post-Second World War economic order of Germany will be analysed. This analysis will also take into consideration the Economic School of Ordoliberalism which emerged in the inter-war period and greatly influenced the construction of the idea of &lsquo / Social Market Economy&rsquo / with its theoretical principles. Some politicians and theoreticians in the post-war period also contributed to the development of the concept. Within this theoretical framework, the post-war economic policies and developments will be surveyed and the newly established economic order will be compared with the ideals of Social Market Economy theoretical programme. In particular, the impact of the Social Market Economy upon the evolution of German Model of Capitalism will be explored by taking into account the significant changes in the role of the state in the economy and the conduct of relations between the social partners especially since the 1960&rsquo / s.

Some innovations are termed ‘disruptive’, a designation that is normally applied to technology; examples include computers, digital cameras, and mobile phones. The term can also be applied to groups of workers, particularly if they are able to offer specific technical capabilities within a market at lower cost, but broadly equal and effective to that offered by traditional products or services. Paramedics could be described in this way and are a newly professionalised group, with distinctive capabilities in terms of responding to the needs of not just the acutely ill and injured, but increasingly those patients with undifferentiated non-life- threatening conditions, which increasingly make up the bulk of 999 call demand. The key to their transition from an artisan, skilled worker to professional status is the acquisition of certain ‘hallmarks’. Perhaps the most important of these is the completion of more prolonged education that affords the opportunity to graduate with enhanced decision-making and other clinical skills in order to meet the needs of the full spectrum of patients in the pre-hospital setting. Paramedics were surveyed to determine how they rated their ‘traditional’ preparation and to establish what their attitudes were to a more educationally based approach. Paramedics themselves proved to be realistic regarding shortcomings in established training and education systems, while also being strongly motivated to learn more within a higher education setting, particularly if this additional effort would result in being able to offer a wider range of care to their patients. During the study, major changes in the health care environment and the role of the Ambulance Service took place, leading to a requirement to undertake a second phase of research. This took the form of ‘Horizon Scanning’ in an attempt to detect ‘signals’, themes and trends in relation to newly emerging ‘competitors’ to the paramedic role. These included nursing, new practitioners and most critically, the rapidly emerging medical sub-speciality of pre-hospital care, staffed by medical personnel on a pattern found specifically in some European countries, sometimes termed the ‘Franco-German’ model/System (FGM/S). Hitherto, the model of provision in the UK had followed the ‘Anglo-American’ model/System (AAM/S), approach, with paramedics providing direct patient care in the field and medical staff largely involved in medical oversight, teaching, clinical governance and other higher level roles. As part of this research, the evidence base for change was examined and consideration given to the factors that might help clarify what the likely situation could be in 2030 in respect of ambulance services, pre-hospital care and paramedics. This future is uncertain, but factors have been identified that would militate in favour of one or other model prevailing, with close links established between educational preparation, system design, career structure and the continuance of the professionalisation process favouring paramedic progression. However, other factors, most specifically professional power, the absence of a clear evidence base and an apparent reluctance to clearly acknowledge this in some respects, lead to the conclusion that the future of pre-hospital care remains uncertain and contested, but also potentially amenable to a well-directed influencing strategy.

本論文內容大體上可分為兩部份，其中之一是組織理論與政策執行模式的探究與對相關研究整理，另一部份則是對西德之「全德事務部」或稱「兩德關係部」、南韓之「國土統一院」及我國之「國家統一委員會」、「行政院大陸委員會」及「財團法人海峽交流基金會」等機關組織進行分析與比較。因之，以前者為經，後者為緯，亦即由組織理論的觀點分析執行國家統一政策之機關，並比較西德、南韓與中華民國三者前述機關組織的相似與相異處，並希望藉由這些組織的安排與制度化過程中所受到之因素影響的探究以瞭解其院作對政策績效亦即對此三個國家統一政策在執行成果上有何影響。