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| Title: | 參與治理下的公共政策決策品質管理--以全民健保牙醫總額預算制度為例
Quality management for policy-making in an era of participatory governance: A study of dental global Budget payment system in Taiwan’s NHI. |
| Authors: | 吳芳瑜
Wu, Fang Yu |
| Contributors: | 陳敦源
Chen, Don Yun
吳芳瑜
Wu, Fang Yu |
| Keywords: | 參與治理
政策利害關係人
決策品質
牙醫總額預算制度
participatory governance
policy stakeholders
decision quality
Dental Global Budget Payment System |
| Date: | 2009 |
| Issue Date: | 2010-04-09 17:06:25 (UTC+8) |
| Abstract: | 在民主改革之浪潮中，政府的運作已從過往獨斷統治模式走向參與治理的型態。參與式治理的呈現方式包括了審議式民主、以公民為中心之協力公共管理、協力治理等型態。公共政策的制定本應以民意為基礎；因此，引導多元利害關係人至公共政策過程之中，共同制定決策即是參與治理的核心，而決策品質的形成關鍵在於政府如何有效管理、促進多元行動者互動以達成決策的參與過程；然而，回顧文獻發現，決策品質主題卻為學界所忽略。因此，本文從參與式治理觀點出發，以利害關係人之角度切入，選擇全民健保總額制度下的牙醫門診總額支付委員會作為個案，嘗試建構出決策品質評估架構。研究發現，由下至上的利害關係人參與過程不但有助於資訊的蒐集與分享、正確地界定問題，亦促進了利害關係人凝聚共識；同時，平等尊重的溝通態度，增強了政策學習功能；加上公共管理者適時地扮演領導角色，有效解決衝突，促進了決策過程的互動與效率。然而，研究亦顯示支委會決策過程仍有不足之處；參與決策行動者之包容性與代表性仍有改善之空間、決策資訊未達公開透明化、法律規範的模糊不清、以及決策原則標準的缺乏。因此，本文建議應該擴大參與團體類別並考量其行動能力，具體強化多元代表參與之可能；同時，應建立法規和參與機制之適當連結，確立相關法律規範，實踐權責分明的決策過程；最後，更應強調互動討論過程的公共商議精神，促進理性決策的落實。此外，也建議學界未來可著力於相關實務經驗研究，設計更為完善的評估架構，以期對於決策品質面向提供更為豐富完整的論述。
Under the trend of democratic reform, the way of public administration has changed from despotic to participatory governance. The forms of participatory governance include deliberative democracy, citizen-centered collaborative public management, and collaborative governance. The core of participatory governance is threefold which includes involving multiple stakeholders into policy-making process, to make decisions collectively, and to base public policy making on public opinion. However, after reviewing the literature, it can be found that seldom are there studies of decision-making quality. The quality of decision making lies in effective management of the process; that is, how to encourage and manage different stakeholders’ interactions to make decisions counts a lot. Consequently, this thesis intends to fill the gap by studying the quality of participatory governance and choosing the committee of Dental Global Budget Payment System as a case to establish evaluation framework of decision-making quality based on policy stakeholder participation theory. The research findings reveal several important insights of committee governance. First, on the good side, bottom-up stakeholders’ participation is beneficial not only to the collection and share of policy information to define proper policy questions, but also to the cohesion of stakeholders’ consensus. The way of equal and respectful attitude to communicate accentuates policy-learning function during the process. Furthermore, public managers play a leading role at the right moment to solve a conflict effectively and to promote the efficiency of decision-making interactions. However, there are some defects about the process. There is some room for improvement about the inclusiveness and representativeness of participation groups. Also, the openness of decision-making information is still far from the standard of transparency. The ambiguity of statutes interpretations and the lack of decision-making principles are critical problems to solve as well. Therefore, this study suggests that the government should include even more diverse and complete stakeholders into the decision-making process and help to increase their competence to participate. Also, an effort to closing the gap between regulations and participative mechanism should be made in order to increase the outside-accountability of the process. Thirdly, the spirit of public deliberation should be highlighted during the interactions to increase the rationality of decision-making. Lastly, in order to create a more adequate evaluation framework, this thesis suggests that academia should devote more time to study the issue of public decision-making quality in the era of participatory governance.
"第一章 緒論 9
第一節 研究背景與動機 9
第二節 研究目的與問題 12
第三節 研究方法 18
第四節 研究範圍 19
第五節 研究流程與章節安排 20
第二章 文獻回顧 23
第一節 從統治(Government)到治理(Governance) 23
第二節 參與式治理、政策利害關係人與協力關係 29
第三節 參與治理模式下的決策品質 38
第四節 全民健保制度下的參與治理 51
第三章 研究設計與實施 58
第一節 研究設計 58
第二節 研究個案 63
第三節 研究架構 73
第四章 案例分析 76
第一節 牙醫門診總額支委會的運作概況 76
第二節 牙醫門診總額支委會的參與情形 84
第三節 支委會決策過程的合法性程度 93
第四節 支委會決策過程的公正性程度 96
第五節 支委會會議的專業性程度 99
第六節 總額支付制度決策品質問題 104
第七節 小結 110
第五章 結論與建議 114
第一節 研究發現 115
第二節 政策建議 124
第三節 研究限制與後續研究建議 126
參考文獻 128
附件一：深度訪談大綱 137
附件二：深度訪談效度檢核表 139
附件三：中央健康保險局牙醫總額支付委員會設置要點 140
圖目錄
圖1-1：總額支付制度中受託單位同儕制約之運作及合法化………14
—以牙醫門診為例....…………………………………………………..14
圖1-2：總額支付制度權責架構圖 ……………………………………20
圖1-3：研究流程圖 ……………………………………………………22
圖2-1：牙醫總額制度組織及分工架構圖 ……………………………59
圖2-2：牙醫門診總額支付委員會委員組成示意圖 …………………62
圖2-3：牙醫總額支付制度執行與規劃過程 …………………………68
圖2-4：研究架構 ………………………………………………………75
表目錄
表1 研究架構之概念化 ………………………………………………50
表2 受訪者列表 ………………………………………………………61
表3 牙醫總額制度大事紀 ……………………………………………71
表4 決策品質評估面向的重要性 …………………………………..123 |
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| Description: | 碩士
國立政治大學
公共行政研究所
95256021
98 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0095256021 |
| Data Type: | thesis |
| Appears in Collections: | [公共行政學系] 學位論文
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