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|Title: ||委員會參與真能回應政策需求嗎？ 以全民健康保險會參與為例之評估|
Can Committee Participation Be Responsive to Policy Demands? An Evaluation of Participation in Taiwanese NHIC
Luo, Kai Ling
Chen, Don Yun
Luo, Kai Ling
national health insurance committee
|Issue Date: ||2016-07-01 15:23:17 (UTC+8)|
Governmental committees are a kind of public participatory mechanism, whereby policy stakeholders are incorporated in the decision making procedure and negotiate with each other to policy outcomes. This mechanism accords with the expectations of both society and government and is frequently used by executive branches all over the world. Ideally, social representativeness can strengthen legitimacy and thereby increase responsiveness. However, in practice, there have also been some criticisms of the committee mechanism, including black box decision making, conflict enlargement, and administrative manipulation. To response this debate, my study addresses whether this type of public participation is responsive to policy demands as well as how to substantially evaluate its effectiveness.
Theoretically, participation has a positive impact on policy demands, I provide more precise analysis using the concepts of representativeness and responsiveness. The former refers to how interests are presented in the decision making process, including in both the formal and substantive dimension. The latter refers to the committee’s ability to respond to procedural and substantive demands from society.
To illustrate the theoretical framework, the National Health Insurance Committee (NHIC) in Taiwan is taken as my case study. The empirical section is divided into two parts, Fist, I explore original guiding values and institutional design of five committees that emerged under different political-social contexts in Japan, South Korea, Canada, Germany and Taiwan. Based on the results of this comparison, the NHIC in Taiwan is my main topic in the second part. The participatory behavior of committee members and their evaluation of the NHIC system are discussed through the various research methods, such as interviews, focus groups, stakeholder surveys, and also context analysis of meeting minutes.
Four results of the study are illustrated as follows: 1. Because the legitimacy of the committee mechanism is empowered by traditional representative authority (the elected legislative or executive branch), it serves a supplementary rather than substitutive function to the existing system. Especially in Taiwan, the administration prefers the advantaged groups more capable of mobilizing social supports over the vulnerable groups which may bring the values of social solidarity and justice into the decision-making of the committee. 2. Stakeholders positively appraised the NHIC’s responsive capacity, both in the procedural and substantive dimensions, with the former appraised more highly than the latter. However, a high level of communication functions had no impact on responsiveness. 3. The institutional variable has no impact on responsiveness. However, direct participation in meetings was associated with more pessimistic views of the NHIC when compared to the non-participators. In addition, the more actors were involved in the NHIC, the more negative their evaluations were. 4. The most significant variable for responsiveness is the decision influence of stakeholders.
Does participation strengthen stakeholders’ responsiveness? Under the condition that individuals are motivated by interest maximization, while institutional design and participatory behavior seek to pursue individual interest, it may not always realize substantial benefits. Furthermore, after becoming institutional insiders, the costs of participation and the political reality of power competition will make stakeholders more skeptical about the responsiveness of committee mechanisms. In other words, whether participation can increase the stakeholders’ satisfaction mainly depends on the benefit they can obtain from it. Without taking into account the link between participatory approaches and results, as well as the interaction between various stakeholders, we cannot gain a full picture of the nature of policy participation.
In terms of practical reforms, to increase performance responsiveness, administrators who control the structures and resources of the NHIC should incorporate different social forces and interests on the input and process dimensions. This will enable the committee mechanism to perform the function of pluralistic participation, rather than simply serving as a political tool for advantaged groups.
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