從民衆觀點建立健保政策績效指標：“重要性－績效分析法”之應用

The Research of Evaluation Indicators of National Health Insurance Policy from the Viewpoints of the Public: Application of Importance-Performance Analysis

劉宜君(I-Chun Liu)

《社會政策與社會工作學刊》 13卷2期 (2009/12) Pp. 143-186

https://doi.org/10.6785/SPSW.200912.0143

摘要

我國全民健保實施以來，維持有高達七成以上的民眾滿意度，同時在國際上的經營績效評比亦獲得相當好的評價。但政府在調整保險費或是調整醫療給付範園時，卻受到民眾的反對，亦惡化健保的財務問題，亦使健保朝向不永績的途徑發展。本研究認爲此一矛盾現象產生的原因，除了健保政策定位混淆的問題外，也在於健保政策績效指標與其績效未普遍獲得民眾認同與社會支持。因此，本研究除透過文獻探討檢視關於從民眾觀點分析健保執行績效的相關研究，並透過電話問卷調查建構民眾對於健保政策績效指標，且以「重要性績效分析法」爲途徑，區分民眾對於健保政策評估指標的重要性與績效滿意度。研究發現從民眾觀點看健保政策績效指標，重要的有「政府在討論關於健保的事情，其決定過程公開農民眾了解」、「可以用最少的錢來照顧民眾的健康」、「以所有民眾其所需要的醫療服務項目，使保是否都有保障」、「健保能否有效提升民眾的健康」、「除了特殊情形(如失業的人、低收入家庭)，每個家庭所能負擔的健保費」、「民眾對於健保的滿意度，以及「民眾至醫院看病時，健保所提供的醫院、醫師數量是否充足」。研究建議針對民眾認爲重要性高的指標作爲評量使保成效的基礎，並針對重要性高、但績效滿意度低的指標，改善其政策執行，如「所有民眾其所需要的醫療服務項目，健保是否都有保障」、「健保是否有照顧到偏遠地區民眾的醫療服務」、「除了特殊情形(如失業的人、低收入家庭)，每個家庭所能負擔的健保費爲基礎」。

關鍵字

全民健康保險 ； 政策評估 ； 績效指標 ； 重要性－績效分析法

並列摘要

For the empirical study, the study implements a telephone opinion survey to collect the general public's opinions and satisfaction about the national health insurance policy implementation. In addition, the study uses ”importance-performance analysis” to display the relationship of importance and satisfaction of the general public about policy performance indicators. The study finds that ”the public” reach the consensus of several performance indicators. These indicators include ”all the people can get their basic medical services which national heath insurance policy can afford” (comprehensiveness indicator), ”people can get basic medical care services even they live in rural or remote areas” (adequacy indicator), ”people can get sufficient medical care services in corresponding to their demand”(adequacy indicator),” the satisfaction of national health insurance policy of the general public” (accountability indicator), ”when the government decides health insurance issues, its decision-making process are open to the public to understand”(accountability indicator) ”the national health insurance can provide necessary services in the most efficient way” (efficiency indicator) ”to enhance the effectiveness of health care of the public general” (effectiveness indicator). The higher the satisfaction indictors of national health insurance policy are ”to enhance the effectiveness of health care of the public” (effectiveness indicator) and ”the national health insurance can provide necessary services in the least costly way” (efficiency indicator)”. The research recommends that the policy evaluation indicators ought to examine and discuss in each two or three years in order to regularly review the public's point of view indicators.

並列關鍵字

national health insurance ； policy evaluation ； evaluation indictors ； importance-performance analysis

參考文獻

劉宜君、傅立葉(2009)。以政策德菲法建構健保政策評估指標之研究。國家與社會。6，103-163。

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