從實務面來看，總額支付制度（global budget）的施行絕非僅止於管制成本的手段，還必須觀照該管理的制度設計。畢竟制度不但能夠彙集各種資源，同時也成為資源使用的指標，影響行動者間的策略選項。另外，針對政策實施後的監控與評估檢討，也是修正制度與提升品質的反饋歷程。然而，學界與實務界在總額支付制度設計原則的研究卻十分有限，究其原因，重要的是主要集中於制度在實際的應用與效果，缺乏以一套適用的「方法」（methodology）來審視。誠如Elinor Ostrom所言，「政策分析家的工具箱有各式各樣的工具，但還缺乏一種具體明確的集體行動理論。」，共有資源管理的例子到處都有，但是分析家卻沒有很好的在理論上總結他們。他藉由制度分析與經驗實例，衍生出來的「制度設計原則」（Design principles），研究各種共有資源管理的問題：從不同類型的資源系統如灌溉系統、捕魚等自然資源或網路資源、財政預算等、到公共財制度研究等，都已經獲得豐碩的成果。本文的主要目標，就是在既有的理論基礎上，討論應用制度設計原則來進行「總額預算評估」的可能內容，並提出政策建議與後續研究的可能內容提出建議。 本文主要分為：（一）導論（二）文獻回顧與理論基礎（三）研究設計（四）中醫總額支付制度的演變（伍）中醫總額的自主管理（六）結論。希冀對學界或實務界在健保改革評估未來的發展，能有所啟發與助益。 / From the practice, global budget is not just the means to control cost, must also take the design of management into consideration. The institution not only can gather various kinds of resources, but also become the indexes, and influence the tactics among the persons who take action to select. Since a global budget married to fee-for-service payments directly analogous to a common-pool resources, we use a framework of design principles to explore the difference of outcomes of management, and to discuss the policy implications about institutional design and financial Incentives. Sincere as what Elinor Ostrom said, ' the policy analyst's box has many kinds of tools , but still lack a kind of concrete and clear collective action theory. ', example there are resource management in common everywhere, but it is the getting better to summarize they in theory. In addition, the “self-governing institutions” designed by each local medical association must be flexibly adapted to the context in which it is applied. To foster the cooperation among physicians, the medical associations of local level should also play the role to provide the institutional setting for collective participatory decision making. The medical associations of national level ought to change the financial incentives facing the physicians to induce the rational patterns of medical behavior so that the allocate efficiency of medical resource and effectiveness of global- budget management can be improved.

中醫按摩源起於遠古時代，早於殷商甲骨文卽有按摩輔助人員之記載，春秋戰國名醫扁鵲併用弟子按摩搶救瀕死患者，戰國秦漢時期《黃帝內經》並以「按龜之法」作為按摩從業人員考覈取材標準，唐朝太醫署按摩科設立官方按摩博士及助理制度；說明中醫按摩法制早已完備。雖自明朝起「按摩」始有「推拿」之稱，清朝並分為十二流派，但按摩推拿法制仍能綿衍不絕。 　　然正當亞洲各國紛紛建立中醫推拿業務法制並重視第三醫學之際，我國行政主管機關卻仍在原地踏步、裹足不前。造成「真正從事中醫推拿助理業務者，無正規學歷與證照考覈管理制度；真正合法醫事人員，卻不從事中醫推拿助理業務且無相關法律配套」之窘境。 綜觀我國憲法、大法官解釋及相關法律規範，並未明文限制人民從事中醫推拿助理之業務。故在就業平等原則下，人民當具有自由選擇為職業之工作權、具有平等接受就業服務及不受歧視之就業與執業機會平等。且各種療法(包括民俗療法)皆存在著風險，甚至已關乎人命問題；是以不論各種療法之風險高低，均應有在職訓練及證照考覈制度管制、相關從業人員身份立法，不應有差別待遇或階級區分。依釋字第666號葉百修大法官協同意見書解釋之精神觀之，行政主管機關應有效提出配套措施、在職訓練及證照考覈制度，實不得以中醫推拿助理所執行之業務非正統醫療、有害社會或不具社會價值為理由，禁止其特定業務活動，使人民得從事該活動之自由『排除於職業自由的保障範圍之外』，藉此淘空憲法所保障中醫推拿助理之工作權。 據此，本論文蒐集歸納歷代與當代中醫按摩推拿歷史及法制文獻；比較當前亞洲國家推拿業務法制與英德日中職業證照制度；分析憲法及現行法秩序下，中醫推拿助理職業自由之保障與限制；並從歷年法院相關實務見解、衛生署行政函釋爭議、立法院質詢改革要點，彙整並比較當前司法、行政及立法機關之見解與措施，並對利弊得失作出評析。最後，提出個人自擬「中醫推拿技術士考覈與管理辦法草案」、「中醫推拿師法草案」及短中長期具體建議，作為未來中醫推拿法制與助理考覈管理改革之重要參考方針。 關鍵字：中醫推拿助理、工作權、職業自由、證照考覈制度 / The Chinese massage originated in ancient times. At the Shang dynasty, the oracle- bone scriptures had already recorded a number of massage assistance personnel . At the Eastern Zhou dynasty, a famous country Chinese herb doctor "pian-chiueh" who rescued the dying with massage therapy by disciples . At the Warring States Period and Qin-Han dynasties , " Laws of pressing the turtle " as the massage employee's standard examination had already described by "Huangdi Neijing(Yellow Emperor's Canon of Medicine)". At the Tang dynasty , imperial government established the official massage doctor and assistant systems . So that Chinese massage system had long been a complete system since then . Althrough "massage" started "tueinar" of call since Ming dynasty, and which divided into twelve divisions at Qing dynasty; the systems of Chinese massage could be still transmitted for ever and ever. However, many Asian countries have established legitimate Chinese massage systems and paid much attention to the third medical science in succession ; but administrative organizations in our country still have hesitated whether to move forward or not.Therefore, those embarrassing situations caused a great deal of trouble to us that" those who engaged in Chinese massage assistants with no formal qualifications and licence examination systems; and those who engaged in legitimate medical personnel with no legal standards of Chinese massage". Taking a comprehensive view of our country Constitution , J .Y . interpretations and related laws,which don't explicitly limit any people engaged in traditional Chinese massage assistants. Therefore , under the principle of equality in employment , people have freely choice of jobs for the right to work as a career;whom have equal acceptance of employment service and free from discrimination of jobs. Various therapies(including folk remedies) all exist risks which even have been already close to human life problems. Based on a variety of treatments regardless of the level of risk,one should have job training, evaluation licence examination systems,the relevant legislation as employees;but should not be discrimination or class distinction. According to the coordination view of J .Y. interpretation NO. 666 by the Honorable Justice Pai- Hsiu Yeh , administrative organizations should put effective integration of on-the-job training and licence examination for Chinese massage assistants ; then those shouldn't forbid their particular business activity in which guaranteed by the Constitution by reason of non-medical, harmful or valueless to the society. Accordingly, this thesis summarized collection of ancient and contemporary history of Chinese massage and legal documents; compared the massage systems in a few Asian countries and occupational licence systems in England , Germany , Japan and China ; analyzed under the Constitution and existing legislation in order to comprehend guarantee and restriction of occupational freedoms for Chinese massage assistants . In addition , it made assessment of the advantages and disadvantages about the related views of judicial , executive and legislature's organs till now. Finally, it proposed the personal draft plans " ordinance draft for Chinese massage technician 's assessment and management " , " law draft for the Chinese massagist " and the short , medium , long term recommendations as important reform references for policy in the future. Key words : Chinese massage assistant , Right to work, Freedom of occupation , Licence examination system

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本論文乃是藉由現代中醫科學研究，進一步指出中醫科學化的可能性及其問題。由於中醫理論十分駁雜，筆者將焦點主要集中於中醫脈診之上，藉由汪叔游和王唯工的研究，來討論中醫脈診科學化的可能性和問題。 本論文進行方式，主要可分為兩個步驟，首先針對傳統中醫理論地位的問題加以討論，其次乃是針對現代中醫實驗。 在第一步驟中，筆者提出一個理論作為科學理論所必須符合的最低標準，即是科學化三原則，分別是：可落實原則、主體際性原則以及系統化原則。藉由科學化三原則筆者嘗試論證傳統中醫並非是科學理論或是經驗有效的理論，最多僅能將中醫醫療實踐視為經驗有效的醫療診斷技術。 在第二步驟中，筆者藉由汪叔游和王唯工的實驗，來討論其經驗上和概念上的問題。藉由兩人的研究，筆者將進一步指出中醫科學化的過程中，必須經過理論的重新建構，而不是僅在於累積客觀的經驗資料就可證實中醫理論。