委員會委員角色評估之研究：以全民健康保險會為初探案例

A study on Niklas Luhmann's political system theory

政府實施二代健保，將「健保監理會」與「健保費用協定會」兩會合一，成立全民健康保險會，負責審議健保費率、給付範圍、決定健保醫療費用的分配。由於健保會委員扮演決定健保醫療費用的分配角色，角色具有重要性，本研究發現較少注意到委員行為的評估，以及委員之間的互動意涵，嘗試透過內容分析法分析健保會的委員會議議事錄，從委員出席、發言、討論與互動情形，初探委員的角色參與與投入情形。研究發現會議發言最多者，以醫事服務提供者代表為多；各類代表在會議中，均有主要的發言委員，某些委員針對各項提案類型均積極參與討論，且發言則數相較其他同類代表明顯為多。最後，研究建議衛福部強化委員自律與他律，以及對於積極參與的委員可優先續聘，以此強化委員的角色扮演。

The government-implemented 2nd Generation National Health Insurance (NHI) scheme involved the merger of the Health Insurance Supervisory Board and the Committee on National Insurance Health Expenses to create the NHI Committee, a body responsible for health insurance rates, adequate pay range establishment, and the allocation of other health care costs. Committee representatives for insurance payers and medical insurance service providers retain the position for two years, with one renewal. In addition, a further stipulation requires no less than a one-fifth turnover of new members every session. On January 29, 2012, the Ministry of Health and Welfare published the NHI Committee’s second session membership list, but did not provide explanations regarding changes in personnel. Given their role in formulating the cost of medical expenses and allocating resources in this area, this research posits that there should be a variety of standards by which the NHI Committee is evaluated, including a substantive analysis of committee meeting agendas and minutes, as well as an evaluation of the role and investment of each committee member. Our research found that while the majority of committee members attend NHI’s monthly meeting, very few members attend the full program of meetings. Those who contributed the most during meetings were representatives of medical insurance service providers, with some members actively broaching a particular proposal and engaging in active debate. The representatives who spoke on behalf of other parties comprised the majority of meeting attendees. In addition to an increase in participation by committee members at meetings, there was a noticeable increase in the strategic nature of their contributions to the discussion. Finally, our research suggests that the Ministry of Health and Welfare should increase their autonomy and heteronomy, and prioritize reappointments to actively participating members to strengthen the roles played by committee members.