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

An Institutional Design to Enhance Citizen Participation in the Policy-Making of Taiwan's National Health Insurance: the Pilot Project of Citizen Conference as an Example

雷文玫(Wenmay Rei)

《臺灣民主季刊》 1卷4期 (2004/12) Pp. 57-81

https://doi.org/10.6448/TDQ.200412.0057

摘要

憲政民主國家中，國家先例公權力的正當性來自民衆的同意。當行政國家的任務，日趨龐雜與專業，國會越業越傾向於授權行政機關基於其救專業與效率，具體的施行細則等行政命令，以因應行政機關動態的決策需求。不過，當立法機關將越來越多的重要決策，授予民意基礎與公開程度都不如自己的行政機關作成時，其正當性何在？如何提昇行政決策的正當性？根據各國立法實務與理論的趨勢，強化公民參與行政決策，是一個可能的郵路。本文以公民會議爲例，試圖在全民健保的行政決策建立制度性的公司參與機制。本文首先檢視由行政機關先例立法權在學理上的正當性，以凸顯公民參與對於強化行政決策正當性的重要性，其次進一步就全民健保行政，探討強化公民參與既有的決策程序的必要性，最後，以公民會議爲例，說明將公民會議納入健保行政決策可能的制度設計。

關鍵字

公民會議 ； 共識會議 ； 公民參與 ； 審議民主 ； 全民健保

並列摘要

The legitimacy of the state exercising coercive power stems from the citizen consensus. However, with the administrative state shouldering increasing responsibilities, the Legislature is increasing by handing its decision-making power to administrative agencies with the expertise to make timely decisions. How can we justify administrative agencies exercising legislative powers? Based on theories and practices in administrative law, this article suggests that citizen participation can be cited as a justification. Using citizen conference as an example, this article seeks to strengthen citizen participation in Taiwan’s national health insurance. This article begins by justifying citizen participation in the administrative agencies’ decision-making, and then looks into the necessity of enhancing citizen participation in Taiwan’s national health insurance. Finally, this article proposes a model to institutionalize citizen conference in the decision-making process of national health insurance.

並列關鍵字

citizen conference ； consensus conference ； citizen participation ； deliberative democracy ； national health insurance

參考文獻

林國明、陳東升(2003)。公民會議與審議民主：全民健保的公民參與經驗。台灣社會學。6，62-118。

郝鳳鳴(2004)。簡論全民健保監理制度民主化。中化法學集刊。14，83-111。

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