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    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/60707


    Title: 新制度主義與政策網絡應用於府際關係之研究：地方政府分擔健保費爭議之案例分析
    Other Titles: Applying New Institutionalism and Policy Networks in Studying Intergovernmental Relations: A Case of Local Governments` Sharing the Subsidy for Premium of NHI Program
    Authors: 劉宜君;陳敦源
    I-Chun Liu;Don-Yun Chen
    Contributors: 政大公行系
    Keywords: 新制度主義;政策網絡;府際關係;全民健保政策;健保費
    new istitutionalism;policy network;intergovernmental relations;National Health Insurance program;premium of NHI program
    Date: 2007-06
    Issue Date: 2013-09-10 14:15:40 (UTC+8)
    Abstract: 本文主要目的在於結合兩個從傳統觀點看來幾乎沒有交集的理論，除試圖建構一種府際關係的新制度論網絡分析外，並藉由關鍵案例應用，以突顯政策網絡途徑在政策過程的價值，以及强化新制度論無法精確描述互動成本的不足。在關鍵案例應用時，嘗試以有別於傳統途徑的觀點討論中央與地方政府之間對於健保費補助款的爭議，將健保費補助款負擔之決策過程視為由中央與地方政府，及地方政府之間形成的政策網絡（府際網絡）中，將府際行動者視為處於資源有限、結構限制與利益競爭的互動水平（地方與地方之間）或垂直（中央與地方之間）的政策網絡中。這些網絡行動者基於政治與經濟利益的考量下，採取不同因應行動，進行政策內容的交涉與結盟，形塑府際網絡之間互賴、衝突與合作的關係，進而對政策結果產生不同的影響。關鍵案例的分析發現，地方政府對於健保費補助款的負擔，原本在正式制度下的合作賽局，因為政治與經濟層面的因素，而變成協調賽局，進而影響嵌套賽局中的中央－地方賽局的互動。因此，後期各地方政府未按時繳足補助款的情形，愈趨普遍，其中「貢獻少，享受多」為府際賽局參與行動者的重要考慮邏輯之一；甚至於欠費地方政府對於以往欠款紛紛採取「長期還款」的態度，並對於健保局要求的利息費用，均表示財政困窘，認為健保局融通資金是財務調度的問題，不應由縣市政府負擔。至於本文研究限制為未區分不同時期各地方政府欠費動機，其可能是因為地方財政的困窘、地方首長施政優先順序的考量、地方首長對於撥付健保補助款的政治意願、對於全民健保法規定不合理的不滿表達、對於中央侵犯地方財政自主權之不滿、缺乏實際規範機制（民國90年度前積欠保費之縣市無罰則），或是因為對於中央統籌分配款公平性的不滿等原因。但本文認為這些原因確實存在。有關地方政府積欠健保費補助款的問題，顯然無法僅採用協商的方式解決紛爭，行政院決議及大法官釋憲亦未能解決健保局與各級地方政府看法上的差異。晚近，前行政院長謝長廷曾提議，將現行健保法中地方政府應負擔之健保費補助款直接修法由中央政府負擔，一勞永逸地解決問題，惟此一方式牽涉社會共識的建立與健保法之修法。因此，如能求得社會共識改變現行相關規定，最終仍須藉由立法院修改健保法的方式來進行，在立法院修法通過由中央全額負擔之前，此一政策議題的變遷值得繼續觀察。
    This paper can be seen as an exploratory research which the authors attempt to integrate theories of new institutionalism and policy network in studying intergovernmental relations. The authors attempt to develop an intergovernmental network-based interaction model by means of literature review and in-depth interview. Then, the authors apply such a nested game model in the analyzing the critical case of dispute between local governments and central government in sharing the subsidy for premium of Taiwan National Health Insurance program. The basic reason is that this policy is implemented in complex organizational network and financial burdens. Interaction and self-interest are the central concept in the dependent model and connects with the possession of resources or with the asymmetry of the dependent relations among policy actors. The research result shows that the new institutionalism network-based analysis can explain contraction and conflict between central and local governments about sharing the subsidy for premium. Also, the authors find either cooperative intergovernmental network or coordinative one that composed of central and local governments are find game theory can reinforce metaphor of policy network research.
    Relation: 社會政策與社會工作學刊, 11(1), 1-52
    Data Type: article
    Appears in Collections:[公共行政學系] 期刊論文

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