全民健康保險委員會決策參與影響因素之探析：社會網絡分析的觀點

Factors Associated with the Decision-making Participation of National Health Insurance Committee Members: Analysis Using Social Network Analysis

臺灣的二代健康保險係透過合議制的健康保險委員會（以下簡稱健保會），負責關於健保費率、給付範圍與年度醫療給付費用總額協定等重大健康保險財務事項的審議。因此，健保會的運作成效與健保財務良窳息息相關。從實務上來說，雖然這種合議制組織在臺灣行政運作上十分常見，但運作成效卻沒有衡量的標準，國內也鮮少有關委員會治理方面的論著可供參考。本研究認為，委員對會議的出席與積極討論，是衡量健保會是否能達到設置目標的基本要件。由於委員會是一個封閉性的群體，彼此間在決策參與中會產生密切的互動，甚至形成非正式組織，影響到決策參與的結果。據此，本研究以委員決策參與為討論標的，探究委員之間的互動關係是否會影響到委員的決策參與行為。據此，本研究以105年度健保會的委員為分析對象，透過社會網絡問卷與105年度的會議實錄蒐集相關資料進行分析。本研究的成果有三：1、如實呈現健保會委員在參與決策過程中的互動關係；2、學者專家與被保險人的影響力較高，位居核心，與會行為較為積極，反之醫事團體代表較為位居邊陲，參與也較不積極；3、委員對於討論事項和專案報告的發言積極度，主要受到委員間資源依賴和法規諮詢關係的影響。本研究並依據以上的研究成果，針對強化委員參與的頻率與品質提出具體的建議。

Taiwan's second-generation NHI is operated by the National Health Insurance Committee (hereinafter NHIC) through a directorial system. The Committee is responsible for the review of major health insurance financial matters, such as the health insurance rate, the scope of payment, and the annual medical payment negotiation under the global budget payment system. Therefore, the effectiveness of the NHIC and the management of health insurance finance are greatly related. In practice, although this directorial organization is very common in Taiwan's administrative operations, its operational effectiveness is not measured. There are currently few studies on committee governance in Taiwan. According to this study, the attendance rate and the enthusiasm of members at the meeting are the basic requirements for measuring whether the NHIC can achieve its goals. Since the committee is a closed group, the members will closely interact with each other in decision-making, and even form an informal organization, which will affect the outcome of decision-making participation. This study takes the decision- making participation of members as the main discussion topic, to explore whether the interaction between the members will affect their decision-making participation behavior. The study investigated the participation behavior of members of the 2016 NHIC and analyzed the data obtained through a social network questionnaire and the 2016 conference record. The results are as follows: 1. Truly present the interaction of members of the NHIC in the decision-making process; 2. The influence of scholars and insured persons ranks the highest, and their participation behavior is more positive. In contrast, the representatives of medical institutions are more at the border, and the level of participation is low; 3. The enthusiasm of the members regarding the discussion items and the project report is mainly influenced by the resource dependence and law consultation among the members. On the basis of the aforementioned results, this study also proposes specific recommendations to strengthen the frequency and quality of committee participation.