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題名：「組合」乎?「市場」乎?--從臺灣變遷中社會的屬性探索全民健保的體制
書刊名：中華公共衛生雜誌
作者：陳孝平 引用關係
作者(外文)：Chen, Michael S.
出版日期：1997
卷期：16:1
頁次：頁86-108
主題關鍵詞：全民健保；利益團體；競租；National health insurance；Interest groups；Rent seeking
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(3) 博士論文(1) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:140
  • 點閱點閱:24
　　　　　全民健保法的規劃，秉持著「經濟學主義」，在技術層面上相較過去之社會保險 有明顯之進步，然而因忽視了「社會面向」及「政治面向」，以致在立法及實施的過程中遭 遇到許多橫逆。此緣臺灣在解嚴之後，社會力倏忽解放，利益團體風起雲湧，而健保規劃當 局未能體察臺灣社會的屬性已大異往昔，未致力在法案設計中，建立協和利益衝突的機制， 實有以致之。 社會保險因可操作的政策工具有限，而所欲達成的目標眾多，具有「過度認定」的本質：滿 足了某些團體，就可能使其它團體的目標落空。在過去威權時代，國家的強制力量可貫徹由 官僚制定的政策，然民主化之後，則問題的解決若不是依靠利益團體之間在平等、互惠、長 期、持續的原則下協商，就只有委之於市場。前者藉「共治」的機制使利益協和，須有「同 舟共濟」的意識；後者雖免於必須由政府裁斷的問題，然而卻難免產生公平等問題。「共治 」的整合主義模式雖為一相對優良之健保組織模式，然而其前提是該社會必須為一「命運共 同體」。若臺灣因故無法具備整合主義之條件，或受貿易自由化、產業外移、外勞進入等影 響，致無法維護固定的社會疆界，而不能依整合主義建構全民健保模式時，則管理式市場模 式即可能成為明知有缺點，但仍不得不接受的最後仰仗。因為捨此而就國家模式，在政府業 已無力主導政策時，很可能因無法應付利益團體之索求而陷入財政危機。
　　　　　The National Health Insurance Act, passed July, 1994, is a victory of economism and scientism, yet spelled a failure of political economy: Taiwan has entered the post-Confucian era and the civil soiety has unleashed its pent-up power, yet the Act still reserves too many authoritarian elements. In particular, the Act lacks in mechanisms for interest reconcilliation, and leaves too much discretionary power in government's hand. Government, therefore, rendered itself victim of rent-seeking advances from various interests. A social insurance program often features too many goals and too few tools and therefore, while some segments of the population may be served, many more may be dissatisfied. In the past when Taiwan was still under the Martial Law, it was easy to enforce any social policy through the coercion power of the state; yet in a democratized society, the social order can be maintained only through market or a corporatist structure in which negotiations are conducted based on principles of parity in power, mutual benefit, long term, and multi-issue. A market model may be free of direct intervention from the state, but could entail problems of inequality; and a corporatist model can not do without codetermination and solidarity. Corporatism based on codetermination is arguable a better model for social cohesion; yet, the precondition is that the society must be a community of common fate, or a society whose boundaries are fixed. Should Taiwan, under impact of globalization of economy, outflow of industries, and inflow of alien labor, can not keep its boundaries unchanged, the corporatist model might not be feasible. A market model, then, becomes a last resort, since the inability of the state to contain interest conflicts might render a social insurance program a "welfare trap".
期刊論文
1.Cohen, L.、Rogers, J.(1992)。Secondary Associations and Democratic Governance。Politics and Society，20(4)，393-472。  new window
2.Frankford, D. M.(1994)。Scientism and Ecoomism in the Regulation of Health Care in Journal of Health Politics。Policy and Law，19(4)，773-796。  new window
3.陳明通、朱雲漢(1992)。區域性聯合獨占經濟、地方派系與省議員選舉：一項省議員候選人背景資料的分析。國家科學委員會研究彙刊：人文及社會科學，2(1)，77-97。  延伸查詢new window
4.陳孝平(19950900)。建華屋於磐石上：論全民健保應有社會基礎。人文及社會科學集刊，7(2)，109-145。new window  延伸查詢new window
5.Elster, J.(1987)。The Possibility of Rational Politics。Archives europeennes de sociologie，28，67-103。  new window
6.Kirkman-Liff, B. L.(1991)。Health Insurance Values and Implementation in the Netherlands and the Federal Republic of Germany: An Alternative Path to Universal Coverage。Journal of the American Medical Association，265(19)，2496-2502。  new window
7.Naaborg, R.(1991)。Changing the Health Care System in the Netherlands: the End of a Period of Cost Containment?。International Social Security Review，44(3)，23-37。  new window
8.Schulenburg, J. M. G.(1992)。Germany: Solidarity at a Price。Journal of Health Politics, Policy and Law，17(4)，715-738。  new window
9.Schmitter, P. C.(1992)。The Irony of Modern Democracy and Efforts to Improve Its Practice。Politics and Society，20(4)，507-512。  new window
10.Iglehart, J. K.(1993)。Managed Competition。The New England Journal of Medicine，328(16)，1208-1212。  new window
11.Day, P.、Klein, R.(1991)。Britain's Health Care Experiment。Health Affairs，3(10)，39-59。  new window
12.Enthoven, A. C.(1991)。Internal Market Reform of the British NHS。Health Affairs，3(10)，60-70。  new window
13.Enthoven, A. C.、Singer, S. J.(1994)。A Single-Payer System in Jackson Hole Clothing。Health Affairs，13(1)，81-95。  new window
14.蕭功秦(19931100)。市民社會與中國現代化的三重障礙。中國社會科學季刊，5，183-188。  延伸查詢new window
15.Arrow, Kenneth J.(1963)。Uncertainty and the Welfare Economics of Medical Care。The American Economic Review，53(5)，941-973。  new window
會議論文
1.陳孝平(1994)。體體制可能之替代方案。人口變遷、國民健康與社會安全國際學術研討會。台北：中央研究院。  延伸查詢new window
2.趙剛(1993)。非正式社會網絡，正式社運組織，與民主。中央研究院民族學研究所行為研究組小型專題研討會系列之十。台北。  延伸查詢new window
學位論文
1.林慧芬(1993)。我國全民健康保險政策制定過程之探討--菁英模型之解析(碩士論文)。國立中正大學。  延伸查詢new window
圖書
1.Harmon, Z.(1988)。Pluralism, Corporatism, and Confucianism: Political Association and Conflict Regulation in the United States, Europe, and Taiwan。Philadelphia：Temple University Press。  new window
2.Saltman, R. B.、Von Otter, C.(1992)。Planned Markets and Public Competition: Strategic Reform in Northern European Health Systems。Open University Press。  new window
3.Muramatsu, M.、Krauss, E. S.(1987)。The Conservative Party Line and the Development of Patterned Pluralism, in The Political Economy of Japan, Vol. 1: The Domestic Transformation。Stanford：Stanford University Press。  new window
4.Dore, R.(1987)。Taking Japan Seriously: A Confucian Perspective on Leading Economic Issues。Stanford：Stanford University Press。  new window
5.Hirst, P.(1994)。Associative Democracy: New Forms of Economic and Social Governance。Oxford：Polity Press。  new window
6.Stone, D. A.(1980)。The Limits of Professional Power: National Health Care in the Federal Republic of Germany。Cnicago：The University of Chicago Press。  new window
7.Arrow, K. J.(1963)。Social Choice and Individual Values。Yale University Press。  new window
8.Field, M. G.(1989)。Success and Crisis in National Health Systems: A Comparative Approach。New York：Routledge。  new window
9.Immergut, E. M.(1992)。Health Politics: Interests and Institutions in Western Europe。Cambridge：Cambridge University Press。  new window
10.Streeck, W.(1992)。Social Institutions and Economic Performance: Studies of Industrial Relations in Advanced Capitalist Economies。London：Sage Publications。  new window
11.Pike, F. B.、Stritch, T.(1974)。The New Corporatism: Social-Political Structures in the Iberian World。London：University of Notre Dame Press。  new window
12.Williamson, P. J.(1989)。Corporatism in Perspective: An Introductory Guide to Corporatist Theory。London：Sage Publications。  new window
13.Kemporen(1994)。Health Insurance and Health Insurance Societies in Japan。Tokyo：National Federation of Health Insurance Societies。  new window
14.Enthoven, A. C.(1988)。Theory and Practice of Managed Competition in Health Care Finance。Amsterdam：North-Holland。  new window
15.Paton, C.(1992)。Competition and Planing in the National Health Service:the Danger of Unplanned Markets。London：Chapman and Hall。  new window
16.HMSO(1990)。National Health Service and Community Care Act of 1990s。London。  new window
17.HMSO(1989)。Working for Patients: Caring for the 1990s。London。  new window
18.Culyer, A. J.、Maynard, A.、Posnett, J.(1990)。Competition in Health Care: Reforming the NHS。London：MacMillan Press Ltd。  new window
19.Appleby, J.(1992)。Financing Health Care in the 1990s。Philadelphia：Open University Press。  new window
20.Butler, J.(1992)。Patients, Policies and Politics: Before and After Working for Patients。Philadelphia：Open University Press。  new window
21.U. S. Gouermment(1993)。Health Security Act。U. S. Gouermment。  new window
22.行政院衛生署(1994)。全民健保以籌組基金會方式之因應方案。  延伸查詢new window
23.Luft, H. S.、Morrison, E. M.、Ginzberg, Eli(1991)。Alternative Delivery Systems in Health Services Research: Key to Health Policy。Cambridge：Harvard University Press。  new window
24.Schelling, T. C.(1978)。Micromotives and Macrobehavior。New York：W. W. Norton。  new window
25.Hirschman, Albert O.(1970)。Exit, Voice, and Loyalty: Responses to Decline in Firms, Organizations, and States。Harvard University Press。  new window
26.Olson, Mancur Jr.(1971)。The Logic of Collective Action: Public Goods and the Theory of Groups。Harvard University Press。  new window
27.Tien, Hung-mao(1989)。The Great Transition: Political and Social Change in the Republic of China。Hoover Institution Press。  new window
28.Olson, Mancur Jr.(1982)。The Rise and Decline of Nations: Economic Growth, Stagflation, and Social Rigidities。New Haven：Yale University Press。  new window
29.陳其南(19920000)。公民國家意識與台灣政治發展。臺北：允晨。new window  延伸查詢new window
其他
1.陳孝平(19940919)。全民健保應建立在社會的磐石上。  延伸查詢new window
2.陳孝平(1994)。給全民健保設計多加一點想像力。  延伸查詢new window
圖書論文
1.Streeck, W.、Schmitter, P. C.(1985)。Community, Market, State--and Associations? The Prospective Contribution of Interest Governance to Social Order。Private Interest Government: Beyond Market and State。London：Sage Publications。  new window
2.徐正光(19900000)。從異化到自主 : 台灣勞工運動的基本性格和趨勢。臺灣新興社會運動。臺北：巨流。new window  延伸查詢new window
3.Streeck, W.(1992)。Inclusion and Secession: Questions on the Boundaries of Associative Democracy。Politics and Society。  new window
4.Schmitter, P. C.(1979)。Still the Century of Corporatism?。Trends Toward Corporatist Intermediation。London：Sage Publications。  new window
5.Brown, L. D.(1992)。Getting There: The Political Context for Implementing Health Care Reform。Implementation issues and National Health Care。Washington, D. C.。  new window
6.Goldthorpe, J. H.(1984)。The End of Convergence: Corporatist and Dualist Tendencies in Modern Western Societies。Order and Conflict in Contemporary Capitalism: Studies in the Political Economy of Western European Nations。Oxford：Oxford University Press。  new window
 
 
 
 
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