The Balanced Scorecard (BSC) was first proposed by Robert S. Kaplan, Professor of Accounting at the Harvard Business School, and David Norton, founder and president of a consulting firm in 1992. They elaborated the idea of strategic measurement system to oversee the performance of a business unit. The system is suitable for both profit and non-profit organizations. After ten years, BSC is proved to be a very powerful tool to inspect the performance of a company, also the implementation of a firm¡¦s strategy. National Health Insurance (NHI) in Taiwan was practiced in 1995. Medical service system had dramatic changes since that time. In order to keep financial balance, NHI develops new policies from time to time, reforms the reimbursement criteria, from fee-for-service to global budget. Hospitals face incessant new challenges. Military hospitals, belonging to non-profit government organizations, play an important role in medical services. It is absolutely important ¡§how to survive under such critical environment, and achieve the goal of permanent operation.¡¨ This thesis is a case study, taking an armed forces hospital as an example to construct its system of strategy management. By implementing the Balanced Scorecard, the hospital can reposition its role according to the mission. Then, the hospital can set up its vision and strategic objectives to draw the strategy maps. Within the four perspectives of the BSC, the hospital can select several measurements to evaluate their performance, then, they can know what has been changed and what needs to be improved. The Balanced Scorecard is the best management tool to implement a company¡¦s strategy. At present, BSC is applied to help strategy management in some hospitals. If it is applicable for a military hospital, it would be a great opportunity to overcome the competitive environment and to achieve the goal to run our military hospital permanently.

On coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operationOn coping with the¡§hospital-based self-management＂ project implemented by the National Health Insurance in Taiwan-----A case study of an Armed Forces Hospital The global budget payment system has been implemented in Taiwan＇s National Health Insurance (NHI) for dental care, Chinese medicine and basic western medicine since 1998, and for Western medicine hospital since 2002. The purpose of this payment system is to control the toal medical expenditure by a fixed annual budget. However, it used in Westewrn medical hospital is so complicated that the fulfillment of this new system will create a new competetion era for the hospitals if without associated set of measures, its complexity is far beyond our detection. The Bureau of NHI therefore carry out variable kinds of mamagement protocols such as ¡§global budgeting system by different area＂,¡§hospital-based self-management＂, and ¡§hospital in pursuit of excellence＂, so that each branch of NHI Bureau will own a fixed amount of budget and negotiate the separate amount with the hospitals. The military hospitals are facing a critical environment; the public budget and personnels of the hospital sponsored by the National Defense Department is decreasing; and the NHI has implemented the global budgeting system which will condense the growth rate of each hospital. The thesis is focusing on the study hospital＇s model of strategic management, establishing a criteria-monitoring system in the hospital in order to analyze the details of the operating performance , when negotiating the growth rate with the Burear of NHI, which is the most important part of the plan for hospital in persuit of excellence, will find out the abnormalities and the solutions for that iii problem. The result of this study showing the management information system in a hospital will provide immediate data, analyze it and help the superintendent make decisions. It is quite critical in such a competitive environment, the information system was proved to be effective and the hospital can achieve the vision of sustainable operation

本研究的焦點主要圍繞在兩大主軸：社會鑲嵌性與決策，探討在行動者間社會網絡的關係結構下，決策的影響力與決策行為的社會性。換言之，本研究認為決策並非僅是理性的產物，更多的時候，反而是理性與非理性因素交互作用的結果。也就是說，決策必然鑲嵌在決策者間的社會網絡關係結構，任何的決策都無可避免的必須考量到決策者間的關係型態所造成的限制。本研究使用牙醫與中醫總額支付委員會作為研究的個案，除了讓社會網絡與決策網絡的邊界更清楚，更符合研究校度之外，也希望能夠進一步透過兩個案的分析，一方面透過社會網絡分析瞭解兩支付委員會可能的權力分佈與結構，二方面分析影響決策權力分佈與決策產出的關係機制為何，並藉此來驗證決策的社會鑲嵌性此一概念。 本研究使用事務討論、信任支持、法規諮詢與資源交換四個社會關係網絡來測量行動者在決策過程中的社會關係，並用以驗證決策者的決策影響力與決策的一致性是否鑲嵌在這四個網絡的結構當中。本研究透過社會網絡的問卷蒐集了牙醫支委會18筆與中醫支委會21筆資料（N=56），並透量化社會網絡分析方法中的集中性指數、派系、網絡密度、區截模型與縮影矩陣、MDS分析與QAP的相關與迴歸分析等分析工具，從個體、小團體層次、與總體的結構層次，分析牙醫與中醫支委會的行動者在網絡中的關係型態與位置角色。此外，更透過上述分析中所獲得的集中性指數的分析結果當作自變項，並放入迴歸模型之中，藉以驗證是否對集體決策產出的觀感造成影響。 總的來說，本研究可歸納以下研究結論：一、在牙醫與中醫支付委員會的個案中，委員決策的影響力與決策行為，確實都受到四個社會網絡結構的影響，驗證了決策的社會鑲嵌性此一觀點；二、無論從個體、小團體或總體結構的分析層次，得到的分析結果都很類似，具有決策影響力並與其他行動者有密切的社會關係的行動者，在牙醫支委會有牙醫全聯會的H11, H16與健保局的A2，但中醫支委會的部分，就沒有健保局的代表，反而僅有中醫全聯會代表，顯見在牙醫部門當中，權力的分佈屬於公、私部門間二元的機制，但中醫的部分僅有集中在中區中醫師；三、委員的出席確實會受到委員個人政策影響力與資源交換網絡的顯著影響，顯示個人政策影響力愈大，與其他委員資源交換關係愈頻繁的委員，參與會議的意願較高；四、從影響集體決策產出觀感的因素來說，事務討論關係與在事務討論網絡的派系重疊程度對集體決策產出的觀感有顯著且正面的影響，個人的決策影響力與年資反而有負面且顯著的影響。 本研究大的貢獻，一驗證了決策的社會鑲嵌性此一觀點，決策必須將社會關係變項考量，二是在公共行政領域中第一本以系統化的方式使用社會網絡分析工具的論文，非但具有示範性的作用，也跨越了過去公共行政網絡研究過於喻象的分析缺陷。根據分析結果，本研究提出以下四點政策建議：一、中醫支委會的健保局代表應當夠積極的與中醫全聯會的代表建立溝通的關係，以構築決策影響力的社會基礎；二、委員會中若不具決策影響力，又在社會關係上沒有跟其他行動者互動，則應考慮其存在的實質意義；三、由於年資長短對決策觀感會有負面影響，健保局應更積極的與年資較久的委員溝通請益，瞭解他們為何會對委員會的運作績效有負面的想法，藉以強化委員會的功能；四、加強委員之間的總額事務討論的交換意見的關係，有助於集體決策的產出。 / Decision making is a collective activity rather than an individual option. In literature, collective action can be symbolized as a network. The concept of network has emerged as an intellectual centrepiece in the field of public administration and the speedy development of social network analysis has facilitated “network research” to go beyond only a metaphor. However, most previous decision theories based on the concept of rationality have not seriously considered a network’s impact on the policy process. This research attempts to verify the causal relationship between social embeddedness and decision-making by examining how policy elites’ personal interactions shape individuals’ decision-making behaviour, influential power and the collective decision performance. This research focuses on the result of the mutual influence between rational and non-rational factors. Two cases (the Dental and Chinese Medicine Global Budget Payment Committees) are discussed by applying quantitative social network analysis in order to systemically expand the current understanding of the power distribution and its influential factors in these two decision making committees in Taiwan’s National Health Insurance domain. In regard to methodology, four participants’ social networks were designed not only to examine the social relationship between these committee members but also to analyse the phenomenon of social embeddedness in these two cases. There are totally 39 successful respondents (apx. 80% response rate, N=56) and these raw data were analysed by the indicators such as network centrality index, cliques, network density, block model, image matrix, MDS and QAP correlation, hierarchical regression in order to answer the research questions. Furthermore, this research is based on three analytical levels in social network analysis: “individual relationship”, “small group” and “global structure”, and not only explores the connection, power exercise and decision-making behaviour between these committee members but also analyses their role and position through the perspective of global network structure. The research verifies the hypothesis “decision-making is embeddeded in the structure of the actors’ interconnected social relationships” and utilizes the quantitative social network analytical method systematically to let network study go beyond a metaphor in the research field of public administration. I conclude that the distribution of the decision-making power and behaviour are both influenced by the committees’ social networks. Furthermore, the power distribution in the dental committee is two cores between the dental association and the BNHI, but the committee of Chinese Medicine is just one core of the Chinese Medicine association. With regard to attendance network as the independent variable, two factors significantly and positively influence the committee members’ attendance network: “decision-making influential network” and “resource exchange network”. Finally, the factors of “the NHI affair discussion network” and “the affair discussion clique centrality degree” have positive statistical significance but relatively the factors of “personal decision making influence” and “seniority” have negative statistical significance on the interviewees’ perception of the collective policy outcome.

在民主改革之浪潮中，政府的運作已從過往獨斷統治模式走向參與治理的型態。參與式治理的呈現方式包括了審議式民主、以公民為中心之協力公共管理、協力治理等型態。公共政策的制定本應以民意為基礎；因此，引導多元利害關係人至公共政策過程之中，共同制定決策即是參與治理的核心，而決策品質的形成關鍵在於政府如何有效管理、促進多元行動者互動以達成決策的參與過程；然而，回顧文獻發現，決策品質主題卻為學界所忽略。因此，本文從參與式治理觀點出發，以利害關係人之角度切入，選擇全民健保總額制度下的牙醫門診總額支付委員會作為個案，嘗試建構出決策品質評估架構。研究發現，由下至上的利害關係人參與過程不但有助於資訊的蒐集與分享、正確地界定問題，亦促進了利害關係人凝聚共識；同時，平等尊重的溝通態度，增強了政策學習功能；加上公共管理者適時地扮演領導角色，有效解決衝突，促進了決策過程的互動與效率。然而，研究亦顯示支委會決策過程仍有不足之處；參與決策行動者之包容性與代表性仍有改善之空間、決策資訊未達公開透明化、法律規範的模糊不清、以及決策原則標準的缺乏。因此，本文建議應該擴大參與團體類別並考量其行動能力，具體強化多元代表參與之可能；同時，應建立法規和參與機制之適當連結，確立相關法律規範，實踐權責分明的決策過程；最後，更應強調互動討論過程的公共商議精神，促進理性決策的落實。此外，也建議學界未來可著力於相關實務經驗研究，設計更為完善的評估架構，以期對於決策品質面向提供更為豐富完整的論述。 / Under the trend of democratic reform, the way of public administration has changed from despotic to participatory governance. The forms of participatory governance include deliberative democracy, citizen-centered collaborative public management, and collaborative governance. The core of participatory governance is threefold which includes involving multiple stakeholders into policy-making process, to make decisions collectively, and to base public policy making on public opinion. However, after reviewing the literature, it can be found that seldom are there studies of decision-making quality. The quality of decision making lies in effective management of the process; that is, how to encourage and manage different stakeholders’ interactions to make decisions counts a lot. Consequently, this thesis intends to fill the gap by studying the quality of participatory governance and choosing the committee of Dental Global Budget Payment System as a case to establish evaluation framework of decision-making quality based on policy stakeholder participation theory. The research findings reveal several important insights of committee governance. First, on the good side, bottom-up stakeholders’ participation is beneficial not only to the collection and share of policy information to define proper policy questions, but also to the cohesion of stakeholders’ consensus. The way of equal and respectful attitude to communicate accentuates policy-learning function during the process. Furthermore, public managers play a leading role at the right moment to solve a conflict effectively and to promote the efficiency of decision-making interactions. However, there are some defects about the process. There is some room for improvement about the inclusiveness and representativeness of participation groups. Also, the openness of decision-making information is still far from the standard of transparency. The ambiguity of statutes interpretations and the lack of decision-making principles are critical problems to solve as well. Therefore, this study suggests that the government should include even more diverse and complete stakeholders into the decision-making process and help to increase their competence to participate. Also, an effort to closing the gap between regulations and participative mechanism should be made in order to increase the outside-accountability of the process. Thirdly, the spirit of public deliberation should be highlighted during the interactions to increase the rationality of decision-making. Lastly, in order to create a more adequate evaluation framework, this thesis suggests that academia should devote more time to study the issue of public decision-making quality in the era of participatory governance.