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    Title: 全民健康保險監理委員會之監督機制探討
    Other Titles: The study of oversight mechanism of national health insurance supervisory committee
    Authors: 江盈儀;Chiang, Ying-Yi
    Contributors: 淡江大學公共行政學系公共政策碩士班
    陳志瑋
    Keywords: 全民健保;全民健康保險監理委員會;行政課責;監督機制;national health insurance;National Health Insurance Supervisory Committee;Administrative Accountability;Oversight Mechanism
    Date: 2011
    Issue Date: 2011-12-28 18:25:22 (UTC+8)
    Abstract: 全民健保是國人引以為傲之制度,卻於實施三年後,陸續浮現相關問題,尤其是在監理會監督健保局的業務權責上,只能僅做表面上的監督,無法針對健保局所負責的業務進行實質的約束力。除此之外,未來監理會與費協會合併為「全民健康保險會」後,各方紛紛都認為可建立起更好的權責相符之全民健保決策機制,但健保會之委員的組成、委員的代表性、主任委員的遴選等問題,在相關文獻中,僅大略地點出問題所在,無明確說明,基於此,這些問題都有待研究與探討。
    就現行監理會整個運作體系觀之,在法律地位上,監理會的實質權力乃是附屬性的;換言之,在整個實質權力分配上,費協會都比監理會來的有主導性。其次,在行政地位上,健保局與監理會乃是平行且對等的單位,但監理會又對健保局負有監督之責,其在執行上是否能達到合法性與合目的性的監督,令人有所存疑。諸多癥結點之處都讓人質疑監理會存在的實質意義。基此,本文之研究目的如下:(一)瞭解全民健康保險監理委員會在全民健保制度所扮演的角色定位。
    (二)分析監理會在運轉相關監督機制時,其可能的工具與預期目標。
    (三)探討如何建立適當的全民健保監督機制。
    在研究方法上,本研究採以「文獻分析法」及「深度訪談法」,找出做為本研究之立論基礎並加以分析及歸納,整理出研究結果與建議,以達到研究目的。
    研究結果發現,一、監理會的參與模式,內部組織成員缺乏有效的溝通對話,促使整個行政組織運作績效低落,無法充分發揮監理會所擁有的監督職責;二、監理會的政策權責,有權責無庸負擔經營虧損之責;有責者卻無權參與健保重大政策之決定,促使體系形成權責分離之漏洞現象,嚴重違反「權責合一」之要求;三、未來健保會之運作,目前監理會運作乃諮詢大於監督,決策大多不具約束力,主要乃是母法不能完全被置信,未來健保會是否能克服此障礙,有待商榷。
    本研究對理論及個案以文獻探討及深度訪談得出的分析結果,整理研究者心得及受訪者意見,茲提出研究建議如下,作為未來健保會運作之參考:一、強化行政幕僚的功能;二、降低代表團體之間的資訊不對稱現象;三、建立一套代表團體之篩選機制;四、強化組織成員的學習與溝通對話;五、強化健保會內部之行政課責。
     It is widely believed that National Health Insurance is a prominent scheme due to the fundamental concept of mutual assistance but It can be argued that there are many problem turn up ever since the establishment of the NHI in 1995 . It can be ascertained that NHI Insurance Supervisory Committee can not provide efficiently supervision towards to Bureau of National Health Insurance. Furthermore, there are a significant numbers of people believed that it is exceedingly to establish a more appropriately decision making mechanism for National Health Insurance after the integration between NHI Supervisory Committee and NHI Medical Expenditure Negotiation Committee into NHI Committee . However, there are a lot of problem did not mentioned clearly enough from the others related literature, such as the representatives and the representations issues for NHI Committee, from this standing, it can be ascertained that issues mentioned above are worthwhile to explore.
      According to the judiciary point of view, the power of NHI Supervisory Committee is subsidiary from the current structure of NHI Supervisory Committee, in other words, NHI Medical Expenditure Negotiation Committee has predominant power compared with NHI Supervisory Committee from the overall distribution of power. Furthermore, Bureau of National Health Insurance and NHI Supervisory Committee are parallel and equal footing units, on the other hand, NHI Supervisory Committee has the obligation to supervise Bureau of National Health Insurance, it can be doubted whether NHI Supervisory Committee can achieve the goal and legality or not.
      There are many suspects on the meaning of the existing NHI Supervisory Committee, therefore the research goals of this literature are three. There are firstly fully understanding the role of NHI Supervisory Committee playing in NHI scheme. Secondly analyzing the supervision mechanism of NHI Supervisory Committee, from tool to the aim of prospective. Thirdly, establishing a more appropriately NHI Supervisory mechanism and how.
      This research uses the study methods of "documental analysis" and the "in-depth discussion" to find out its theoretical basis, analyze and conclusion to sort out the findings and recommendations to its purpose.
      The results and analysis of this research are based on theories and individual cases by adopting both Documentary Analysis and In-Depth Interview, therefore this paper may provide some possible solutions for the future development of Bureau of National Health Insurance.
    There are enhancing the function and responsibilities of administrative body, reducing the information asymmetry among representative groups, establishing a better screening mechanism, and last enhancing the communication and professional skills.
    Appears in Collections:[公共行政學系暨研究所] 學位論文

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