頁籤選單縮合
題 名 | An Analysis of Health Care Reform and Structural Interests: A Public Choice Approach=醫療照護改革與結構利益:公共選擇途徑之分析 |
---|---|
作 者 | 劉宜君; | 書刊名 | 中國行政評論 |
卷 期 | 14:2 2005.03[民94.03] |
頁 次 | 頁77-106 |
分類號 | 412.56 |
關鍵詞 | 公共選擇; 醫療照護; 利益團體; 官僚; 醫療保險; Public choice; Medical care; Interest group; Bureaucracy; Medical insurance; |
語 文 | 英文(English) |
中文摘要 | 本文係以公共選擇途徑分析兩種主流的健康照護改革政策,一是主張醫療保險市場的自由競爭,二是主張由政府介入醫療市場的運作,這兩種觀點都僅指出部份的事實,也各有支持者。所謂的公共選擇理論基本假設為是一個自利的、理性的、追求效用極大化的個體。因此,研究者認為利益團體的形成與參與政治活動是基於相當狹隘的白利動機,希望藉由提供好處給行政官僚,使其獲得留任或是升遷的機會,與行政官僚形成命運共同體,而行政官僚賦予利益團體獲得使用公共資源的優勢地位,以極大化彼此的利益。因此,希望獲得利益的利益團體,有誘因去影響政府的決策;而既得利益者,亦會繼續影響行政官僚的決策,以維持其既得利益。 以公共選擇途徑分析這兩種截然不同的改革觀點,發現行政官僚與醫師團體因為自利動機的考量,會支持不同觀點的醫療照護改革主張,通常利益團體偏好讓醫療市場自由運作,以使其發揮醫療專業的知識與能力,獲取利益。而行政官僚則希望介入醫療保險市場的運作,以獲得操縱公共資源的權力。 在進行步驟上,作者將先闡述公共選擇途徑的架構輿論點。其次,說明兩種醫療照護改革的措施,尤其著重在其結構利益。再者,將以公共選擇途徑分析不同型態的醫療改革模型與其造成的影響。最後,則提出研究發現與政策建議。研究發現從公共選擇觀點探討醫療改革政策,政府偏好繼續介入醫療市場的運作,其設計的改革方案亦是對於自身最有利的內容。 |
英文摘要 | In the paper, I will use the approach of modem public choice theory to discuss two major viewpoints of the health care reform models. The two different perspectives of "market" and "bureaucratic" reform models are based on different empirical assumptions about the role and the motivation of physicians and bureaucrats. Public choice approach is concerned with the fact that individuals in a democracy have an incentive to try to influence governmental decisions. I try to show that particular individuals will gain if either of the policies is adopted and that they have an incentive to try to influence the choice of policy. If individuals are already receiving benefits, they have an incentive to try to maintain them. If they are not receiving benefits, they have an incentive to try to persuade politicians to make policies that yield benefits to them. In either case, they often find that their voice is more likely to be heard if they join special interest groups. We can expect that different powerful interest groups will throw their political support behind each of the reform models mentioned above. More specifically, these groups will use a substantial amount of resources to shape and influence the outcomes of policy implementation. I will start with an overview of theoretical framework of public choice approach in application of public policy analysis. Then, I will introduce two major types of reform paradigms by focusing on their arguments and structural interests. After that, I will examine the impact of public choice approach on two types of health reform models. The last section of this paper is a brief summary and policy recommendations. |
本系統中英文摘要資訊取自各篇刊載內容。