公民會議與審議民主：全民健保的公民參與經驗

Consensus Conference and Deliberative Democracy: Citizen Participation in Taiwan's National Health Insurance Policies

「公民會議」（或稱「共識會議」）是種創新性的公民參與模式，其目的在建構一個公共討論的場域，讓一般公民們，能夠了解改革議題，並在知情的條件下，經由理性溝通而形成共同的意見。這種公民參與政策討論的模式，相當接近於「審議民主」所揭櫫的理念。台灣在2002年七、八月，以全民健保給付範團為議題，首度舉辦公民會議。本文旨在分析這場「全民健保公民會議」的實踐經驗。我們從公共討論的動態過程和效果，來檢證審議民主一些核心的理論命題。從公民會議的經驗分析中，我們發現：公民們具有了解複雜的政策議題的興趣和能力，而且能夠在尋求共善和共識的取向下，理性地討論政策議題；參與公共討論的過程，同時也能夠提升公民的知識與積極性的公民德行。我們的分析討論也指出公民知能對公民參與和理想的公共討論的重要性。協助公民取得政策知能，有助於建構公共討論的溝通框架，形成共同關切的問題，並促成理性特質、共識取向的討論。而在參與公共討論的過程所獲得的公民知能，包括特定的政策知識、廣泛的政策訊息，以及實踐公民權利的心智能力，則能夠進一步養成積極關心、參與公共事務的公民德行。我們因而認為，只要提供適當的參與管道，對公民進行知能的賦權，公民是有能力從公共利益的觀點，對政策議題進行理性的討論。

The aim of consensus conference, an innovative form of citizen participation, is to create a public forum in which citizens participate in rational, informed discussions and reach reasoned agreement on controversial policies. The international expansion of this experimental democratic mode is concurrent with the theoretical trend of deliberative democracy. In 2002, Taiwan held its first consensus conference on the topic of national health insurance policy. The authors analyze the dynamics of the deliberative process and its effects on participants to test several major propositions on deliberative democracy. It was noted that a) the deliberative process displayed characters of rational argumentation, mutual respect, public spiritedness, and consensus orientation; and b) participation in public deliberation has increased citizens' knowledge about policy issues, changed values and policy preferences, and fostered a sense of active citizenship. This analysis points to the importance of civil literacy for successful public discussion and citizen participation. Citizens' heightened understanding of policy issues helped to constitute a communicative framework of public discussion and to facilitate rational, consensus-oriented deliberation, and the civil literacy acquired from the process was instrumental in furthering civic engagement. The authors conclude that civil competencies, active citizenship, and public spiritedness can be fostered by providing adequate channels for citizen participation in public debates.