菁英與民眾對於政策意見之一致性研究：健保政策評估指標之案例分析

Evaluation Indicators of National Health Insurance Policy: Comparisons of Opinions of the Elites and the General Public

10.6171/ntuswr2011.24.01

劉宜君(I-Chun Liu)

全民健保 ； 政策評估 ； 評估指標 ； 菁英 ； national health insurance ； policy evaluation ； evaluation indicators ； elite

臺大社會工作學刊

24期（2011 / 12 / 01）

1 - 37

繁體中文

本研究有別於過去以專家或民眾為單一研究對象的健保政策評估研究，結合「由上而下」與「由下而上」方式蒐集實證資料。先利用政策德菲法蒐集專家對於健保政策評估指標的意見，並以專家共識高的指標作為民意調查問卷的基礎，再利用電話調查法蒐集民眾對於健保政策評估指標的意見。研究發現，健保開辦已十餘年，菁英與民眾具有高度共識的評估指標著重在醫療資源配置、制度課責與資源使用效率等面向，計有七項，包括：「民眾需要的醫療服務項目，健保保障的程度」（完整性指標）、「健保照顧到偏遠地區民眾的醫療服務」（適足性指標）、「民眾到醫院看病時，醫院、醫師數量充足的程度」（適足性指標）、「民眾對於健保的滿意度」（課責性指標）、「以最少的錢來照顧民眾健康的程度」（效率性指標）、「提升民眾健康的程度」（效能性指標）、「政府討論健保公開讓民眾瞭解的程度」（課責性指標）。研究建議，除了財務平衡指標外，菁英與民眾具有共識的指標作為健保政策成效評量指標，以符合專業與民主參與的原則。

The present study discusses evaluation indicators of the National Health Insurance policy, incorporating opinions from the elites and the general public. The empirical study implemented the policy Delphi method to obtain the elite opinion on evaluation indicators of the National Health Insurance policy, while a telephone opinion survey collected the general public opinion. Results indicated that the elites and the general public reach a consensus on several evaluation indicators. These indicators include, ”All people can obtain basic medical services which the national health insurance policy can afford” (comprehensiveness indicator), ”People can obtain basic medical care services despite living in rural or remote areas.” (adequacy indicator), ”People can obtain sufficient medical care services according to their demands” (adequacy indicator), ”General public satisfaction with the national health insurance policy” (accountability indicator),” When the government decides on health insurance issues, its decision-making processes are open for public understanding” (accountability indicator), ”The national health insurance can provide necessary services in the most efficient way” (efficiency indicator), and, ”To enhance the effectiveness of the health care of the public in general” (effectiveness indicator). The higher satisfaction indicators of the national health insurance policy were, ”To enhance the effectiveness of the health care of the public in general” (effectiveness indicator) and, ”The national health insurance can provide necessary services in the least costly way” (efficiency indicator). These findings indicate that performance assessment indicators should integrate the opinions of different representative sections of the population, professional and democratic principles of decision-making.

1. 吳宛蕙、楊長興(2007)。全民健保對健康差距之影響─以平均餘命為測量。台灣公共衛生雜誌，26(3)，196-207。
   連結：
2. 劉宜君(2009)。從民眾觀點建立健保政策績效指標：「重要性―績效分析法」之應用。社會政策與社會工作學刊，13(2)，143-186。
   連結：
3. 劉宜君、傅立葉(2009)。以政策德菲法建構健保政策評估指標之研究。國家與社會，6，103-163。
   連結：
4. Henke, K. D., & Schreyögg, J. (2004). Towards sustainable health care systems: Strategies in health insurance schemes in France, Germany, Japan and the Netherlands – A comparative study. Retrieved November 1, 2009, from http://www.ww.tu-berlin.de/diskussionspapiere/2004/dp09-2004.pdf
5. Beck, R., & Camarota, S. A. (2002). Elite vs. public opinion: An examination of divergent views on immigration. Retrieved July 16, 2010, from http://www.cis.org/articles/2002/back1402.html
6. Government of Canada. (1984). Canada Health Act Bill C-3 Statutes of Canada, 32-33 Elizabeth II (RSC 1985, c 6; RSC 1989 c C-6).
7. 內政部（2008）。〈歷月人口統計資料〉。上網日期：2009 年9 月30 日，取自內政部戶政司全球資訊網頁http://www.ris.gov.tw/gateway/population.cgi?s_code=m1&sheet0name=s2
8. Abelson, J.,Forest, P. G.,Eyles, J.(2003).Deliberations about deliberative methods: Issues in the design and evaluation of public participation processes.Social Sciences & Medicine,57,239-251.
9. American College of Physicians(2008).Achieving a high-performance health care system with universal access: What the United States can learn from other countries.Annals of Internal Medicine,148(1),55-75.
10. Brady, H. E.,Sniderman, P. M.(1985).The attitude attribution: A group basis for political reasoning.American Political Science Review,79,1061-1078.
11. Carmines, E. G.,Kuklinski, J. A.(1990).The two faces of issue voting.American Political Science Review,74,78-91.
12. Crosby, N.,Kelly, J. M.,Schaefer, P.(1986).Citizen panels: A new approach to citizen participation.Public Administration Review,46,170-178.
13. de Loe, R.(1995).Exploring complex policy questions using the policy Delphi: A multi-round, interactive survey method.Applied Geography,15(1),53-68.
14. Deber, R. B.(2003).Health care reform: Lessons from Canada.American Journal of Public Health,93(1),20-24.
15. deLeon, P.(1992).The democratization of the policy sciences.Public Administration Review,52,125-129.
16. Dow, W.,Schmeer, K.(2003).Health insurance and child mortality in Costa Rica.Social Science & Medicine,57(6),975-986.
17. Dye, T. R.(1998).Understanding public policy.Upper Saddle River, NJ:Prentice-Hall.
18. Foyle, D. C.(1997).Public opinion and foreign policy: Elite beliefs as a mediating variable.International Studies Quarterly,41(1),141-169.
19. Ginsburg, P. B.(2008).,Princeton, NJ:Robert Wood Johnson Foundation Synthesis Project.
20. Graham, T. W.(1989).Massachusetts Institute of Technology.
21. Ham, C.(Ed.),Coutler, A.(Ed.)(2000).The global challenge of health care rating.Buckingham, England:Open University Press.
22. Innes, J. E.,Booher, D. E.(2004).Reframing public participation: Strategies for the 21st century.Planning Theory & Practice,5(4),419-436.
23. Institute of Medicine(2001).Crossing the quality chasm: A new health system for the 21st century.Washington, DC:National Academy of Sciences.
24. Katz, E.,Lazarsfeld, P. F.(1965).Personal influence: The part played by people in the flow of mass communications.New York, NY:Free Press.
25. King, S. C.,Feltey, K. M.,Susel, B. O.(1998).The question of participation: Toward authentic public participation in public administration.Public Administration Review,58(4),317-326.
26. Lupia, A.(1994).Shortcuts vs. encyclopedias: Information and voting behavior in California insurance reform elections.American Political Science Review,88,63-76.
27. Maney, A.,Plutzer, E.(1996).Scientific information, elite attitudes, and the public debate over food safety.Policy Studies Journal,2,42-46.
28. Miller, D. T.,McFarland, C.(1987).Pluralistic ignorance: When similarity is interpreted as dissimilarity.Journal of Personality and Social Psychology,53,298-305.
29. Mondak, J.(1993).Source cues and policy approval: The congitive dynamics of public support for the Regan agenda.American Political Science Review,37,186-212.
30. Paul, D. M.,Brown, C.(2001).Testing the limits of elite influence on public opinion: An examination of sports facility referedums.Political Science Quarterly,54(1),871-886.
31. Saltman, R. B.,Busse, R.,Figueras, J.(2004).Socail health insurance system in western Europe.New York, NY:Open University Press.
32. Spicker, P.(1995).Social policy: Themes and approaches.Hertfordshire, England:Prentice-Hall.
33. Wen, C.-P.,Tsai, P.-S.,Chun, I. W.-S.(2008).A 10-Year experience with universal health insurance in Taiwan: Measuring changes in health and health disparity.Annals of Internal Medicine,148(4),258-267.
34. White, O. F.,McSwain, C. J.(1993).The semiotic way of knowing and public administration.Administrative Theory and Praxis,15(1),18-35.
35. Worcester, R. M.(1993).Public and elite attitudes to environmental issues.International Journal of Public Opinion Research,5(4),315-334.
36. Zaller, J. R.(1992).The nature and origins of mass opinion.New York, NY:Cambridge University Press.
37. 江東亮(2006)。醫療窮人不再有。台北:臺大出版中心。
38. 余致力(2002)。民意與公共政策─理論探討與實證研究。台北:五南。
39. 余致力、黃榮護(2001)。論專業民調在政策形成過程中之角色。行政管理論文選輯，15，229-246。
40. 吳明隆、涂金堂(2009)。SPSS 與統計應用分析。台北:五南。
41. 林昭吟、陳敦源、劉宜君、蕭乃沂(2007)。二代健保保費改革方案預評估─民眾與菁英對改革方案之認知與偏好的比較。行政暨政策學報，44，1-30。
42. 傅立葉(2006)。行政院衛生署委託研究計畫行政院衛生署委託研究計畫,行政院衛生署。
43. 董鈺琪(2005)。行政院衛生署委託研究計畫行政院衛生署委託研究計畫,行政院衛生署。
44. 蔡昆達(2005)。碩士論文(碩士論文)。國立成功大學都市計劃研究所。
45. 蔡鶯鶯(1998)。行政院衛生署中央健康保險局八十七年度委託研究計畫行政院衛生署中央健康保險局八十七年度委託研究計畫,行政院衛生署中央健康保險局。