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| Title: | 民眾公平觀感與民眾滿意度之關連：以台灣全民健保政策為例
Perceptions of equality and citizen satisfaction: a study of NHI in Taiwan |
| Authors: | 黃汎如 |
| Contributors: | 陳敦源
陳麗光
黃汎如 |
| Keywords: | 民眾滿意度
新公共管理
程序正義
實質正義
citizen satisfaction
New Public Management
procedural justice
substantive justice |
| Date: | 2008 |
| Issue Date: | 2009-09-19 13:08:09 (UTC+8) |
| Abstract: | 有鑑於八０年代新公共管理(NPM)的興起對公共行政帶來重大的影響，其顧客導向的主張，刺激了顧客滿意度調查在公部門廣泛的應用。然而回顧過去公私部門重要的民眾滿意度調查，發現評估指標幾乎都著重在效率、效能面，而公共行政引以為本的公平價值卻少見探討。因此，本研究選取對人民影響最基本但重大的全民健保政策為個案，嘗試建構一個兼顧效率與公平面的民眾滿意度模型，並將焦點置於公民公平觀感與滿意度之間關連性的探討。在資料的蒐集上，採用國家衛生研究院「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日進行的電話訪問調查，經扣除遺漏值後，共有2478份樣本。本研究所建構的民眾滿意度ordered probit模型以「健保滿意度」為結果變項，解釋變項則包含了基本人口社經背景、以及效率效能面和公平面的指標。經實證結果發現，過去一直被強調的效率效能指標對健保滿意度確實產生顯著影響，但民眾對健保政策的主觀公平觀感也被證實與滿意度有顯著關連；換句話說，如果政府進行民眾滿意度調查時，未能含括公平面指標，則其所獲得的資訊將不能完整表達民眾的心聲。但本研究亦發現公民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觀感必需具有明確的政策背景。
In the past three decades, new public management (NPM) has a great impact on the field of public administration. Among the impacts, “customer orientation” is the most influential one. For the purpose of evaluating citizen satisfaction on government services, public agencies begin to utilize the Customer Satisfaction Survey (CSS) mainly designed and administrated by business managers. However, after reviewing the content of the CSS questionnaires, we find that the emphasizing values behind the CSS are efficiency and effectiveness rather than equality, which is sometimes the main value behind public service delivery. Whether value of equality will influence citizen’s level of satisfaction is the main research question of this thesis. We take Taiwan’s National Health Insurance (NHI) as a case study, and utilize a citizen survey on priority setting of the NHI from the National Health Research Institutes in late 2007 as the secondary data. The dependent variable of our citizen satisfaction ordered probit model is “NHI satisfaction”, and explanatory variables including demographic backgrounds, indexes about efficiency or effectiveness, and indexes about equality. The results show that efficiency and effectiveness have significant association with NHI satisfaction. Most importantly, the citizens’ general evaluation on the equality of NHI also has a significant impact on the NHI satisfaction. According to the results, we suggest that applying CSS into public service evaluation should include index about equality in order to capture the holistic picture of citizen satisfaction. |
| Reference: | 行政院衛生署中央健保局（2007），《全民健保與您牽手12年：成長與蛻變》。
江逸之（2008），〈2008年幸福城市大調查：永續管理比盲目建設重要〉，《天下雜誌》，第406期，頁102-109。
李美華等譯（1998），Babbie, E.著，《社會科學研究方法》，台北：時英。
余致力（2000），〈論公共行政在民主治理過程中的正當角色：黑堡宣言的內涵、定位與啟示〉，《公共行政學報》，第4期，頁1-29。
吳肖琪（1991），《健康保險與醫療網區域資源對醫療利用之影響》，國立臺灣大學公共衛生學硏究所博士論文，未出版。
吳瓊恩（2002），〈公共行政學發展趨勢的探究：三種治理模式的互補關係及其政治理論的基礎〉，《公共行政學報》，第7期，頁173-220。
林進財、陳啟斌、吳文祥、陳稚均（2006），〈台灣地區實施全民健康保險後醫療資源公平性之研究〉，《環境與管理研究》，第7卷第2期，頁53-66。
林震岩（2007），《多變量分析：SPSS的操作與應用》，台北：智勝文化。
林上祚、江慧真，〈克魯曼：台灣健保 全球最好〉，《中國時報》，2009/5/16，A1版。
林美姿、黃漢華（2009），〈竹市三連貫，高縣桃縣中市苗縣登五星〉，《遠見雜誌》，第276期，頁108-114。
徐永明（2001），〈政治版圖：兩個選舉行為研究途徑的對話〉，《問題與研究》，第40卷第2期，頁95-115。
許立一（2002），〈新公共管理的省思：以黑堡觀點為基礎〉，《公共行政學報》，第6期，頁29-65。
陳世敏（1991），〈民意調查與台灣的民主化：以施政滿意程度與公眾人物的聲望調查為例〉，《新聞學研究》，第45期，頁101-118。
陳敦源（1999），〈顧客導向的省思與再突破：尋找服務的誘因結構〉，《空大行政學報》，第9期，頁209-235。
陳敦源、陳麗光、黃東益、呂佳螢（2008），〈公共行政研究中之正義制度的設計與執行：以全民健保資源配置機制為例〉，發表於全國公共行政系所聯合會年會（TASPAA），台中市：東海大學公共行政暨政策學系主辦。
陳美霞，〈健保美夢還很遙遠〉，《中國時報》，2009/5/22，A26版。
楊志良（1999），〈全民健保財務負擔的幾點迷思與困境〉，《中華公共衛生雜誌》，第18卷第2期，頁85-86。
雷文玫（2004），〈強化我國健保行政決策公民參與的制度設計—二代健保先驅性全民健保公民會議的建議方案〉，《台灣民主季刊》，第1卷第4期，頁57-81。
劉宜君（2001），〈我國全民健康保險政策財務之實證研究〉，《中國行政評論》，第10卷第4期，頁129-176。
鄭文輝（2001），〈Social Health Insurance in Taiwan: Current Status and Perspectives〉，《保險專刊》，第64期，頁1-45。
Boyne, G. A. (2002) “Public and Private Management: What’s the Difference?” Journal of Management Studies, 39(1): 97-122.
Bozeman, B. (1987) All Organizations are Public, London: Jossey-Bass.
Brown, K., & Coulter, P. B. (1983) “Subjective and Objective Measures of Police Service Delivery,” Public Administration Review, 43(1): 50-58.
Brown, T. (2007) “Coercion versus Choice: Citizen Evaluations of Public Service Quality across Methods of Consumption,” Public Administration Review, 67(3): 559-572.
Chen, D. Y., Huang, T. Y., Hsiao, N. Y. (2006) “Reinventing Government through On-Line Citizen Involvement in The Developing World: A Case Study Of Taipei City Mayor’s E-Mail Box In Taiwan,” Public Administration And Development, 26: 409-423.
Cumberford, J.; Gordon, G.; & Sinha, N. N. (1999) “The Creation of a National Citizen Satisfaction Index,” Quality Congress. ASQ`s 53rd Annual Quality Congress Proceedings, 53: 595-600.
Dolinsky, A. L., & Caputo, R. K. (1990) “The Role of Health Care Attributes and Demographic Characteristics in the Determination of Health Care Satisfaction,” Journal of Health Care Marketing, 10(4): 31-39.
Daniels, N. (1981) “Health-care Needs and Distributive Justice,” Philosophy and Public affairs, 10(2): 146-179.
Daniels, N. (2001) “Justice, Health, and Healthcare,” American Journal of Bioethics, 1(2): 2-16.
Daniels, N., & Sabin, J. (1998) “The Ethics of Accountability in Managed Care Reform,” Health Affairs, 17: 50-63.
Denhardt, R. B., & Denhardt, J. V. (2000) “The New Public Service: Serving Rather Than Steering,” Public Administration Review, 60(6): 549-559.
Etter, J. F., & Perneger, T.V. (1997) “Validating A Satisfaction Questionnaire Using Multiple Approaches: a Case Study,” Social Science & Medicine, 45(6): 879-885.
Frederickson, H. G. (1997) The Spirit of Public Administration, San Francisco, Calif.: Jossey-Bass Publishers.
Green, R. T., & Hubbell, L. (1996) “On Governance and Reinventing Government,” in Wamsley, G. L., & Wolf, J. F. (eds.), Refounding Democratic Public Administration: Modern Paradoxes, Postmodern Challenges, pp.38-67. CA: Sage.
Hart, D. K. (1974) “Social Equity, Justice, and the Equitable Administrator,” Public Administration Review, 34(1): 3-11
Haviland, M. G., Morales, L. S., Dial, T. H., & Pincus, H.A. (2005) “Race/Ethnicity, Socioeconomic Status, and Satisfaction With Health Care,” American Journal Of Medical Quality, 20(4): 195-203.
Kelly, J. M. (2005) “The Dilemma of the Unsatisfied Customer in a Market Model of Public Administration,” Public Administration Review, 65(1): 76-84.
Kurland, N. B., & Egan, T. D. (1999) “Public v. Private Perceptions of Formalization, Outcomes, and Justice,” Journal of Public Administration Research and Theory, 9(3): 437-458.
Musa, R., Pallister, J., & Robson, M. (2005) “The Roles of Perceived Value, Perceived Equity and Relational Commitment in a Disconfirmation Paradigm Framework: An Initial Assessment in a `Relationship-Rich` Consumption Environment,” Advances in Consumer Research, 32: 349-357.
Nagel, S. S. (1984) Public Policy: Goals, Means, and Methods, New York : St. Martin`s Press.
Okun, A. M. (1975) Equality and Efficiency: the Big Tradeoff, Washington : The Brookings Institution.
Oliver, R. L. (1980) “A Cognitive Model of the Antecedents and Consequences of Satisfaction Decisions,” Journal of Marketing Research, 17: 460-469.
Oliver, R. L. (1997) Satisfaction: A Behavioral Perspective on the Consumer, New York : McGraw Hill.
Olsen, J. A. (1997) “Theories of justice and their implications for priority setting in health care,” Journal of Health Economics, 16(6): 625-639.
Osborne, D., Gaebler, T. (1992) Reinventing Government, NY : Plume.
Poister, T. H., & Henry, G. T. (1994) “Citizen Ratings of Public and Private Service Quality: A Comparative Perspective,” Public Administration Review, 54(2): 155-160.
Rawls, J. (1999) A Theory of Justice, Cambridge, Mass.: Belknap Press of Harvard Univeristy Press.
Röhl, K. F. (1997) “Procedural Justice: Introduction and Overview,” in Röhl, K. F., & Machura, S., Procedural Justice, pp1-35, Aldershot, England: Ashgate.
Ross, C. K., Steward, C. A., & Sinacore, J. M. (1993) “The Importance of Patient Preferences in the Measurement of Health Care Satisfaction,” Medical Care, 31(12): 1138-1149.
Rothstein, B., & Teorell, J. (2008) “What is Qualty of Government? A Theory of Impartial Government Institutions,” Governance, 21(2): 165-190.
Ryzin, V., & Gregg, G. (2004) “Expectations, Performance, and Citizen Satisfaction with Urban Services,” Journal of Policy Analysis and Management, 23(3): 433-448.
Saha, S., Arbelaez, J. J., & Cooper, L. A.(2003) “Patient-Physician Relationships and Racial Disparities in the Quality of Health Care,” American Journal of Public Health, 93(10): 1713-1719.
Stone, A. D.(1997) Policy Paradox: The Art of Political Decision Making. New York: W. W. Norton.
Tsuchiya, A., Miguel, L. S., Edlin, R., Wailoo, A., & Dolan, P. (2005) “Procedural Justice in Public Healthcare Resource Allocation,” Applied Health Economics and Health Policy, 4(2): 119-127.
Vermunt, R. & Törnblom, K. Y. (2007) Distributive and Procedural Justice : Research and Social Applications, Aldershot, England: Ashgate.
Vigoda, E., & Yuval, F. (2004) “A National Assessment Project of Public Administration: Theoretical Framework and Preliminary Findings from Israel,” Public Administration Quarterly, 28(4): 501-537.
Vigoda-Gadot, E. (2006) “Citizens’ Perceptions of Politics and Ethics in Public Administration: A Five-Year National Study of Their Relationship to Satisfaction with Services, Trust in Governance, and Voice Orientations,” Journal of Public Administration Research and Theory, 17: 285-305.
Walzer, M. (1983) Spheres of Justice: A Defense of Pluralism and Justice., New York: Basic Books.
Ware, J. E., Snyder, M. K., Wright, W. R., & Davis, A. R. (1983) “Defining and Measuring Patient Satisfaction with Medical Care,” Evaluation and Program Planning, 6(3-4): 247-263.
White, B. (1999) “Measuring Patient Satisfaction: How to Do It and Why to Bother,” Family Practice Management, 6(1): 40-44.
Wilson, J. Q. (1989) Bureaucracy : What Government Agencies Do and Why They Do It, New York: Basic Books.
WHO (2000) The World Health Report 2000: Health Systems : Improving Performance, World Health Organization.
WHO (2002) The World Health Report 2002: Reducing Risks, Promoting Healthy Life, World Health Organization.
WHO (2003) The World Health Report 2003: Shaping the Future, World Health Organization.
WHO (2005) The World Health Report 2005: Make Every Mother and Child Count, World Health Organization.
WHO (2006) The World Health Report 2006: Working Together for Health, World Health Organization.
WHO (2008) The World Health Report 2008 : Primary Health Care Now More Than Ever, World Health Organization. |
| Description: | 碩士
國立政治大學
公共行政研究所
95256016
97 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0095256016 |
| Data Type: | thesis |
| Appears in Collections: | [公共行政學系] 學位論文
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