On the one hand, the orientation of the organizational institution of the National Health Insurance (NHI) program is related with the design of the structure; on the other hand, the different patterns it adopted also involve with the structure of the payment and medical expense. Among the issues of NHI, this one has been the most difficult problem to reach consensus. Currently, the NHI legal system was designed mainly as a model controlled by government. Owing to the lack of substantive social participation, it has caused the problem of ”player-umpire” and accountability under the guidance of the Department of Health (DOH). Furthermore, monopolization of insurance and medical service resource of a single-carrier has also made disputes as well.Concerning about the problems of the organizational institution, NHI is scheduling a structural and institutional reform in the Second Generation NHI program- a two-staged reformation proposal of ”establishing an accountable NHI organizational institution”. In the first stage, the Supervisory Board and Negotiation Committee for Medical Expenses will be united and replaced by the NHI Supervisory Committee. In the second stage, the Bureau of NHI and some related units of the BOH will be combined to establish the administrative juristic person of NHI agency in charge of policy decision and administrative implementation. Yet, there are still some questions which require further examination, such as whether the improvement will achieve the goal of accountability, which path people will participate, and the possibility of establishing a competitive system.This study focuses on the above questions, and will start with the issues reflected by the current organizational institution of NHI. Then, we should clarify the contents of the two-staged organizational institution improvement in the Second Generation NHI, and use ”accountability” as a criterion to examine the new program. Eventually, the discussion will bring up suggestions based on arguments concluded.