An Analysis On the Policy Network of the Legalization Process ofthe Second-generation National Health Insurance

• Main Authors: SUI-HUI-WANG, 王素惠
• Other Authors: Chin-peng Chu
• Format: Others
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/zt8bev

碩士 === 國立東華大學 === 公共行政學系 === 102 === Taiwan’s National Health Insurance has existed for 19 years since its implementation. Although it has a number of achievements, financially it has some problems, such as unfairness in 6 categories and 14 items and a rigid and unstable premium calculation base. As these problems worsen, adjustment and reforms in finance for the NHI have been facing difficulty. And the 2nd-generation NHI, which started out from financial problems, incorporated reform schemes regarding medical expenditure. However, no progresss had been made until January 2011, when it was legalized. As a result, this study selected to aim at the legalization process of the 2nd-generation NHI policy. It employed and discussed the interaction of mutual dependence in resources between policy stakeholders to serve as a principle policy network theory and proceed to construct this study’s analysis structure. Regarding the internal resources of the legalization process of the 2nd-generation NHI policy, authority, funds, legitimacy, information and organization proposeciple policy network theory and proceed to construct this study’s analysis structure. Regarding the internal resources of the legalization process of the 2nd-generation NHI policy, authority, funds, legitimacy, information and organization proposed by Phodes (1988) which can affect relations between network members, were applied to discuss the influence of resources on policy stakeholders. Regarding external relations, based on the questions compiled by Marsh & Phodes (1992) which were discussed by a majority of researchers; integrity, resource distribution, interaction in authority between network members, etc., were subdivided into interaction and negotiation & consensus. This is to discuss the exchange of resources between policy stakeholders, their willingness to communicate, the results of their interaction, their consensus on the objectives, etc. In so doing, we may understand the pattern of the network and the effects of governance regarding the legalization process of the 2nd-generation NHI policy. In respect of methodology, this case study gathered needed information by indepth interview and secondary data. On the interviewees list were policy stakeholders of some main groups who are affected in the legislation process of the 2nd-generation NHI, including the Legislative Yuan, the the Department of Health, (DOH, currently the Ministry of Health and Welfare), the Bureau of National Health Insurance, social groups, medical groups, experts and researchers, etc. Research results show that involvement by policy stakeholders in the policy network of the legalization process of the 2nd-generation NHI differed. This is mainly because resources possessed by every policy stakeholder differed, and so did the dependence they need. For example, as experts and scholars possessed knowledge related to planning of the 2nd-generation NHI, the legislative Yuan, the DOH, the Bureau of National Health Insurance, and so on, needed them to provide knowledge and theory related to planning of an NHI law. As a result, their interaction also differed. In light of internaction process and consensus in the legalization process of the 2nd-generation NHI policy, policy stakeholders differed. This is mainly because those who had more and higher frequencies to interact had more opportunities to communicate and exchange opinions. Therefore, the degree to which their consensus in negotiation can reach was higher. For instance, medical groups had higher satisfaction in interaction and higher consensus in negotiation. By contrast, a lack of information, as well as a lower frequency in interaction with each policy stakeholder, gave social groups a relatively lower satisfaction with the policy. Apart from experts & researchers and social groups who were not satisfied with the legalization process of the 2nd-generation NHI policy; the Legislative Yuan, the DOH, the Bureau of National Health Insurance, and medical groups expressed satisfaction with their interaction process. However, regarding policy satisfaction, only the Legislatitve Yuan and medical groups were satisfied, whereas the DOH and the Bureau of National Health Insurance were not satisfied. This is principally because the 2nd-generation NHI act was highly controvertial, which affected the achievement of the policy goal as well as the satisfaction.