民眾公平性觀感與滿意度關聯性之研究 －－以台灣全民健保政策為例

A Research on the Association between Public Perspectives on Fairness and Satisfaction: The Case of Taiwan's National Health Insurance

[研究緣起與問題] 新公共管理自1980s年代興起以來，對公 共行政帶來重大的影響，其中顧客導向的主張，更引進了私部門 顧客滿意度調查在公部門廣泛的應用。同時因為民主化的推波助 瀾，政府將民眾視為「頭家」，更加突顯民眾滿意度的重要。然 而，回顧過去公部門民眾滿意度調查，發現評估指標著重在效率 或是效能面，缺乏公共行政引以為本的公平性價值探討。有鑑於 此，本研究以全民健保政策為個案，嘗試建構一個兼顧效率與公 平性面向的民眾滿意度模型，並將焦點置於民眾公平性觀感與政 策整體滿意度之間關連性的探討。 [研究方法與資料] 透過國家衛生研究院「衛生醫療體系優先 順序之制定的研究」於2007年12月1日至12月24日以電話訪問調 查所蒐集的2478份有效樣本為主要資料來源，以排序性常態機率 模型（ordered probit）統計方法。其中「健保整體滿意度」為依 變項，自變項則包含了基本人口社經背景以及有關效率與效能面 和公平性面向的指標。 [研究結果與建議] 統計分析結果發現，與民眾健保整體滿意 度有顯著關聯的變項包含：人口社經背景變項中，「年齡」的老 年人口及「居住地」；效率與效能面指標中的「主觀健保品 質」、「民眾對健保服務的價值認知（效能）」及「民眾付出之健 保價格負擔（效率）」；公平性面向指標中，民眾對健保「決策公平性」的評價、民眾在「健康的人是否應分擔生病的人的醫療費用」這方面的「實質公平性」觀點以及在「發聲管道」標準的「程序公平性」的態度。從這些實證結果可看出，除了過去一直被強調的效率與效能指標對健保整體滿意度產生顯著影響，民眾對健保政策的主觀公平性觀感也被證實與整體滿意度有顯著關連；顯示政府進行民眾滿意度調查時，若未能包括公平性面向指標，調查可能會有盲點而無法偵測到民眾評價政策的一些關鍵條件。但本研究亦發現民眾對健保政策以外的公平性態度並未顯著的影響健保滿意度，因此，民眾滿意度調查中測量公平性觀感必需具有明確的政策背景。

In the past three decades, new public management (NPM) has had a great impact on the field of public administration. Among the impacts, “customer orientation” is the most significant one. For the purpose of evaluating citizen satisfaction with government services, public agencies begin to use the Customer Satisfaction Survey (CSS) mainly designed and administered by business managers. However, after reviewing the content of the CSS questionnaires, we find that the emphasized values behind the CSS are efficiency and effectiveness rather than equality, which is sometimes the main value behind public service delivery. Whether the value of equality will influence citizens' level of satisfaction is the main research question in this thesis. We took Taiwan's National Health Insurance (NHI) as a case study, and used a citizen survey on priority setting by the NHI from the National Health Research Institutes in late 2007 as secondary data. The dependent variable in our citizen satisfaction ordered probit model is “NHI satisfaction.”, and explanatory variables included demographic backgrounds, indexes of efficiency or effectiveness, and indexes of equality. The results show that efficiency and effectiveness have a significant association with NHI satisfaction. Most importantly, citizens' general evaluation of equality with regard to NHI also has a significant impact on NHI satisfaction. Based on the results, we suggest that the application of CSS in public service evaluation should include an index of equality in order to capture a holistic picture of citizen satisfaction.