The Evaluation of Taiwan National Health Insurance Policy Implementation─An Analysis of the State, Policy Networks, and Capacity of Financial Monitoring
Executive Summary
In the Ph.D. dissertation, I integrate approach of public policy process and state-centered theory as well as the concept of policy network to evaluate the autonomy and policy capacity of the state in implementing Taiwan National Health Insurance (NHI) policy. Also, I discuss the power structure of the state in distributing medical resources and its value. The analysis framework and main contents are as follows:
First, I introduce the concept of the state to replace the government or the political system to enlighten the importance of state autonomy and capacity in implementing public policies. Second, I use the concept of policy networks to describe state/interest group relations. Third, the focus of the research is to evaluate the degree of state autonomy and to analyze its policy preference in implementing NHI. Finally, the focus of empirical analysis is to employ multiple regression models to evaluate the state capacity in management and monitoring the growth of medical expenditures.
The key findings are the nature of the relationships between state actors and interests groups and the impact that these relationships have on policy outcome. There is some evidence that the state indeed has the capacity to contain the growth of health care expenditures and to increase the revenues of insurance premiums. Also, the empirical study shows that the impact of the ratio of aging citizens and the number of physicians upon the growth of national medical expenses.
Recently, the balance of insurance revenues and medical expenditures is unstable. The policy analysis recommends a key to maintaining financial status is to ensure the implementation of the initial principle of policy design in order to achieve consistency in premium rates, premium collection, benefits, and payment standards.