- 學位論文
二代健保政策推動之媒體報導分析：以保費新制為例
A MEDIA ANALYSIS OF THE FINANCING SCHEME OF THE PHASE П NATIONAL HEALTH INSURANCE PROGRAM
摘要
民主國家中福利政策的推動過程，媒體對於政策的解讀經常是民眾的接受度、立委的質詢、官員施政考量之來源，但媒體與福利政策推動之關係卻鮮少被探究。因此本研究從社福政策推動為關懷點，以內容分析法的分析基礎，輔以質性資料的分析，以分析保費新制的推動上媒體報導的內容作為主要的研究目的，研究對象鎖定在中國時報、聯合報、民生報與自由時報等四大平面媒體上。 內容分析的項目包括了新聞類型、消息來源、健保現制問題（包括了現制健保支出面問題與收入面問題的報導分析）、保費新制內容、報導語氣、報導方式、報導定位等，之外，更因為媒體報導量集中於特定事件的發生（密集度達66.5%），因此以前述各項目的分析之外，將特殊事件的發生亦納入論文的量化分析的變項當中。 從研究分析結果來看，在2005年到2006年間媒體報導集中於六個特定事件的發生上：健保公民會議、健保十周年研討會、林志玲墜馬事件、衛署版規劃草案出爐、謝內閣總辭前臨時院會、規劃草案進入立院等，而且僅於林志玲墜馬事件到衛署規劃草案出爐後、和政院版規劃草案入立院時才有持續性的報導，媒體並非長期的關注，越是建制化事件（衛署版規劃草案出爐、規劃草案入立院）的發生越容易受到媒體報導。 林志玲墜馬事件發生後，媒體報導量才有較明顯的成長，此事件的發生亦使保費新制的媒體報導整體呈現出前後期的差異，前三個事件點上的媒體報導大致呈現出由官方消息來源主導，且有利政策改革推動的方向，但是後三個事件點的陸續發生，媒體報導呈現越來越不利保費新制推動的方向、甚至到當時執政的民進黨團必須釋出強烈反對繼續推動二代健保的立法行動；從林志玲墜馬事件發生後的媒體報導實質內容來看，林事件使民間社會對於保費新制的期待湧升，希望官方消息來源能夠釋出更多更詳細的規劃方向、更開放地與社會對話，但官方消息來源在媒體上呈現出閉門造車的形象，成為眾矢之的，加之以規劃的不完整更使保費新制的推動成為2006年的停滯狀態。 從林事件的發生亦可看出民間基金會、學者專家、醫療團體等對於健保改革推動的期待與了解，對於實際政策的規劃亦有相當的對話能力，但是媒體與衛生行政官方在傳統上強勢地訊息壟斷，因此難以在健保改革議題上佔有一席之地，在林事件發生之後媒體上需要更多健保改革的訊息，但官方消息來源在媒介上的封閉態度，使民間輿論更易出線，後續健保改革推動時，民間團體有更多公共空間可以參與。
並列摘要
In a democratic society, the media has played an important role in shaping public opinions regarding government policies. Nevertheless, the relationship between welfare policy and the media has rarely been studied in Taiwan. This thesis intends to explore the roles of the media in the promotion of the Phase II National Health Insurance Program with special reference to it financing scheme. This thesis has referred to the research conducted by Collins et al. (2006) about the 2002 Canadian health care reform debate, which exploring four media effects by examining Canadian newspapers. The method employed in this research is content analysis. The research has identified 198 clippings about the report of the financing schemes of the Phase II NHI, gathered from four newspapers: the China Times, the United Daily News, the Min Sheng Daily News, and the Liberty Times. These materials have been coded into quantitative data and analyzed with the statistical software. The categories of the quantitative data include the type of the news, the source of information, the subject of the report, the tone and position of the news, and so on. Besides, qualitative analysis of these reports has been conducted in order to supplement the interpretations of the quantitative analysis. The research findings are as follows. Six periods of intensive reports from January 2005 to June 2006 can be identified, following such key events as the NHI Consensus Conference, the 10th anniversary of the NHI implementation, the falling of the famous model (Lin, Chi-Ling) from horseback, the NHI revised draft proposed by the DoH, the resignation press conference of the Premier Hsieh, and the NHI revised draft reviewed by the Legislative Yuan. In the first three periods, the government was the main source of the information and could dominate the report to some extend. Also, the media reports about the Phase II NHI tended to be in a positive tone. The injury of the famous model Lin and the following treatments uncovered the issue of the unfair sharing of the NHI contribution fees and therefore the Phase II NHI had attracted the public attentions. More information was needed by the public, but the officials seemed to be more uncertain about the details of the Phase II NHI. At the same time, non-official sources of information coming from scholars, experts, medical professionals, and NGOs were shown on the media. The tone of reporting the financing scheme had gradually changed from positive to negative and may influence the passage of the NHI revised draft based on the Phase II NHI Planning in the Legislative Yuan.