論全民健康保險政策參與權

On the Right of Policy Participation of National Health Insurance

林伯殷(Bor-yin Lin)

指導教授 ： 李瑞全

國立中央大學/文學院/哲學研究所/博士(2014年)

摘要

台灣全民健康保險政策的規劃與執行，是由菁英領導逐漸轉向至多元的參與，與台灣民主化進程有密切的關聯，也就是政策推行時必須面對更多意見的粹練。本文旨從接受健康照護的權利及社會公義的面向論述全民健康保險政策參與權，期能建構合宜的政策參與原則及程序，以促進健保資源的公平分配。
全民健保政策面臨著資源有限、需求無限的困境，加上政策參與之不足，極易造成健保資源分配不公的現象。本文藉諾門•丹尼爾斯（Norman Daniels）提出之健康照護公義理論，結合，其列示十個健康照護改革基本公平性標記之一的「公共之可問責性」（public accountability），指出台灣全民健保政策參與在公開程序、公民參與及公民自律等面向之不足，除需要改革健保制度外，同時，也需要從健康權及健康照護權等方向來補足政策參與之道德基礎，才能強化健保政策參與權之合理性。
鑑於全民健康保險政策參與程序屬於約翰•羅爾斯（John Rawls）指稱之不完美程序公義（inperfect procedural justice），難以找到可以完全達成目標之程序，因此，對於政策參與之程序要有更具體的原則，在此前題下，本文依循公開程序、公民參與及公民自律等面向，建立健保政策參與之模式，並提出各面向需要遵守之原則及做法，期能為健保政策開闢更合理之參與途徑。除此，健保能否永續經營，還取決於是否具有相應之政策參與價值，本文提出代表傳統文化之儒家人之為人，及代表個人權利之健康促進等二項概念，期能提升健保政策之社會公義。

關鍵字

全民健保 ； 社會公義 ； 政策參與 ； 儒家 ； 丹尼爾斯

並列摘要

The planning and implementation of National Health Insurance（NHI）policy of Taiwan is a gradual shift from elite to pluralistic participations. The process is closely related to the course of democratization in Taiwan. It means that government policy decision have to meet more feed backs from civilians in implementation. This thesis aims to discuss the right of policy participation of NHI from the perspectives of the right to receiving health care and social justice, in order to construct principles and procedures of popular policy participation, and to promote equitable distribution of health care resources.
NHI policy, facing the difficulties of limited resources and unlimited demand, coupled with lack of policy participation, easily result in inequitable distribution of health care resources. This thesis analyses the insufficiency of civilian participation of Taiwan's NHI in policy decision-making, citizen participation and citizen autonomy according to the benchmark of public accountability formulated by Norman Daniels. The whole health care system needs to be reformed and, at the same time, it also need be reset upon the moral basis for policy participation from the right to health and health care, in order to strengthen the reasonableness of the right for popular participation in the health insurance policy.
In view of policy participation’s procedure of NHI is a kind of imperfect procedural justice（John Rawls）, it is difficult to become a procedure to fully achieve the goal of complete justice. Therefore, the principles involved in procedures of policy participation should be more specific. In this thesis I propose, according to the principles of open procedure, citizen participation and citizen autonomy, a pattern of policy participation of NHI decision-making and the principles and courses of practice for the three aspects. This would develop into a more reasonable way for policy participation of NHI. In addition, for the sustainable operation of NHI, in needs concept of the value of citizen participation, which I present according to the traditional Confucian culture of person as person. Together with the individual’s right to health promotion, it could improve the social justice of NHI’s policy.

並列關鍵字

national health insurance ； social justice ； policy participation ； Confucianism ； Norman Daniels

參考文獻

楊志良，1990年，《公共衛生新論》，台北：巨流。

林國明、陳東升，2003年，〈公民會議與審議民主：全民健保的公民參與經驗〉，刊於，《台灣社會學》，第6期，頁80-98。

陳志豪、張可臻、林忠順，2012年，〈全民健保單一保險制度的優缺點〉，刊於《家庭醫學與基層醫療》，第27卷，第6期，頁222-225。

楊志良，2009年，〈未來健保政策趨勢與國際經驗分析〉，刊於《衛生醫療政策》，第3卷，第6期，頁46-51。

江東亮、余玉眉，1994年，〈健康促進：國民健康的新方向〉，刊於《中華衛誌》，第5卷，第13期，頁381-387。