本文基本上是從「制度結構與行動主體之間的相互再生產過程」的觀點，以「轉診業務」的若干實踐形式為例，說明健保體制做為臺灣醫療場域最主要的一種制度性結構力量，對於醫療院所以及醫師專業地位團體業務執行的可能影響；同時，也將進一步檢視相關效益對健保體制所可能產生的某些重塑作用。 在「文化慣習」、「地理宥限」等若干結構面因素的限制之下，以「其它方式執行」，甚至「不執行」轉診業務相關的形式規範，似乎才是符合行動主體現實利益的「實質理性」；此外，「業務報酬」與「專業學習」等實務面「醫療利益」的考量，也是影響轉診業務執行方式與程度的關鍵因素。 而從本文的觀點看來，在健保體制的影響之下，轉診業務的執行無法落實，甚至產生醫療資源分配與使用偏斜的社會疑慮，其實是「制度結構與行動主體之間相互再生產過程」的一種體現。當然，其整體所體現的相關效益，或可承認為是制度規範「形式理性」與行動主體「權宜性組織利益實質理性」之間差距的進一步拉近；但不一定即意味著「制度性社會利益實質理性」的必然體現或轉化。

From the perspective of "the processes of the reciprocal reproduction between institutional structure and active subject", National Health Insurance Institution (NHII) as an institutional structure will influence the active characteristics of medical actors. In the referral practice, the influential effects of the normative power of formal rationality will be "restructuring", owing to the substantive rationality of medical actors. The structural effects such as cultural habitus and geographical limitation combine with the practical considerations of "occupational payment" and "professional learning" of physicians, leading the referral practice to fail in deed. In views of this article, the referral practice can not be worked effectively, representing and elaborating "the processes of the reciprocal reproduction between institutional structure and active subject". Of course, the representation of relative effects could be recognized as the gaps between normative thinking of "formal rationality" and "contingent organizational interest of substantive rationality" more and more closely. But, it dose not means the establishment of "institutional social interest of substantive rationality" will transform automatically.