近年公私部門協力關係的建立，成為政府整合服務輸送資源、滿足民眾需求的新興治理模式，然此模式是否真能有效達成政策目標，實令人好奇。對於公私協力執行成效的評估，國外已有研究討論，反觀國內相關的評估文獻卻屈指可數，基此，本研究將以執行成效評估的角度出發，以「循證的公共管理」（evidence-based public management）思維，評估健保局總額支付制度下公私協力的執行成效，藉此驗證何種因素對於公私協力成效具有影響。本文首先透過文獻檢閱，歸結過去研究所提出的執行成功要件，並建構一套評估指標系統，以總額支付委員會的124 位委員進行面對面問卷訪問調查；本文發現：首先，不論健保局內部運作或醫事團體內部自主管理，保持上下與平行單位間暢通的溝通管道，將有助於協力執行的成效。再者，健保局內部點值監控的擬定，醫事團體內部專業審查人員的推派及相互監督機制的發揮等，亦會影響協力執行的成效。最後，本文針對成效評估結果，於末了提出三項政策建議：其一，健保局內部組織運作的調整、其二、強化醫事團體的自主管理、以及其三、委員會權利與義務的清楚界定等，提供政府部門在推行總額支付制度改革作為時之參考。 In recent years, building public-private partnership (PPP) is the popular way to satisfy citizen demands through delivering government services Compared with other countries’ experiences, there has been a problem of lacking systematic evaluations of various PPP applications in Taiwan. The purpose of this study is to utilize survey technique to evaluate the Global Budget Payment System of the Taiwanese National Health Insurance (NHI). First, an evaluating scheme is established from existing literatures. Second, the members of the Global Budget Payment Committee are face-to-face interviewed to evaluate the PPP. The eighty out of 124 members were responded and the response rate is around 65%. This research finds that the structural factors have positive influence on the effectiveness of PPP for both governments and medical associations. And, the symbolic dimension of public organization has a positive impact on the effectiveness of the partnership. Also, the dentist and Chinese medicine participants evaluate the partnerships better than those in hospitals and localclinics sections. However, the members from the southern section of the payment system have a lower evaluation of the partnership. Based on the above findings, this research concludes with three policy suggestions: some adjustments of internal operation in Bureau of National Health Insurance, increasing the autonomy of medical groups to manage their professional operations, and redefining and balancing rights and obligation of the Global Budget Payment Systems Committees.
公共行政學報, 42,99-137 Journal of Public Administration National Chengchi University