由於我國目前實施的牙醫總額預算搭配論量計酬支付方式，其性質類似「共有財產資源」，本文乃應用共有財產資源分析架構，來解釋我國牙醫門診總額支付制度實施之後，不同地區（中區與南區）牙醫師之間互動所致的總額管理成效差異，並兼論制度設計與財務誘因之改良。學理上，共有財產資源的管理能否成功，其影響條件繫乎「情境因素」與「管理機制」，本文乃藉由這兩大面向來探索中區與南區牙醫總額賽理成效差異的原因。初步研析發現南區總額管理較為成功，其原因為：（一）在情境因素方面，中區牙醫師面臨較大的經濟壓力，較不利於同儕合作；（二）在管理機制方面，「集體參與決策機制」、「清楚說明使用規則」、「有效的監督系統」以及「漸進式的懲罰機制」等四項管理原則或制度設計，是促使南區總額管理較為成功的重要因素。在政策意涵上，經由本文分析可知，由於「使用者」（醫療專業）的性質以及「資源」（總額預算）的性質，使得醫師們的接受度益形重要。醫療專業習於自主與自治（自我管理），醫師們比較容易接受的是醫界內病的解決方式，而非從外部強加在醫界身上的力量。目前總額支付制度的管理模式既然是由健保局（各區分局）與牙醫師全聯會（各區分會）「共同管理」，本文建議醫、政雙方各自的權責應儘速釐清並合理劃分，以降低政、醫之間以及醫界內部的衝突；還有，在醫療團體方面，各區牙醫總額保委會所設計的「自我管理機制」若能配合情境因地制宜，並促進參與者之間的合作，例如同儕制約規則制訂機能更為民主化，使會員醫師對總額預算的接受度與配合度較高，則總額支付制度運作自然較容易成功；此外，全聯會亦應儘速合理改良財務誘因（例如修改支付標準表、改革支付基準、促進並強化電腦檔案分析審核等），以導正醫療為模式，增進醫療資源配置效率與總額管理效率。

The Global Budget System for dental care has been implemented in Taiwan for four years. Since a global budget married for fee-for-service payment is directly analogous to a common-property resource, we use a framework of common-property resource to explore the difference of outcomes of management between Mid-Taiwan district and south Taiwan district, and to discuss the policy implications about institutional design and financial incentives. Theoretically, a successful, sustainable management of such common-property resources—global budget—depends on the “contextual factors” and “management arrangement”. Focus on these two aspects to understand the experiences in Mid-Taiwan and south Taiwan, we find the latter is more successful than the former because: 1). At least initially, the global budget in Mid-Taiwan put greater economic pressure on its dentists than did it in south Taiwan; 2). Four main management principles or institutional designs are helpful for south Taiwan to succeed which includes collective participatory decision-making arrangements, clearly specified rules of use, effective monitoring mechanisms and graduate sanction mechanisms. The medical profession is accustomed to autonomy and self-regulation. Physicians more readily accept solutions from within the profession than any imposed from outside. Now that the global budget is co-managed by government and medical associations, we suggest the responsibilities between these two should be defined clearly and rationally to reduce the conflicts. In addition, the “self-governing institutions” designed by each local medical association must b flexibly adapted to the context in which it is applied. To foster the cooperation among physicians, the medical associations of local level should also play the role to provide the institutional setting for collective participatory decision making. The medical associations of national level ought to change the financial incentives facing the physicians to induce the rational patterns of medical behavior so that the allocative efficiency of medical resource and effectiveness of global-budget management can be improved.