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

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 decisionmaking.