行政部門委員會為政府內具有公共參與特質的合議制組織，來自社會層級的利害關係人被納入決策圈，並共同決定政策內容，作者稱之為委員會參與機制。此決策模式結合了社會與政府對公共參與的期待，並在世界各國廣泛使用。行政管理者宣稱可透過社會代表性的提升，提高政策的正當性與回應性；但實務上，委員會卻遭遇密室協商、激化對立、政治操弄等質疑。對此，本研究提出以下疑問：公共參與是否真能回應社會的政策需求？該如何具體評估參與績效？ 依據委員會的決策結構特質，作者由公共參與的理論視野探討代表性和回應性的因果機制，提供一套以委員會為主體的參與評估標準。代表性在理論上有形式與實質代表性兩個層次，共包含參與制度、議事行為與會議影響力三個面向；回應性則強調利害關係人對委員會回應需求的主觀評價，又分為民主程序與實質利益的需求回應能力兩類。參與概念落實在制度賦權和議事行為，應該會同時強化兩類回應性。在研究方法上，本文以全民健康保險委員會為分析案例：首先透過跨國比較，分析台灣、日本、韓國、加拿大以及德國在類似的審議機制中，如何建構委員會代表性的制度。依此基礎，再針對第一屆健保會的運作進行分析，透過利害關係人問卷、健保會會議記錄內容分析、深度訪談與焦點團體等方法，深入探討健保會之政策回應能力。 研究結果發現：一、委員會參與的制度賦權和正當性皆來自代議機關，尚無法取而代之。台灣健保會之形式代表性，在行政單位主導下仍偏好具有政治動員能力的團體，較忽略社會連帶或保障弱勢的價值。二、健保會在民主功能和實質結果兩個回應性面向的評價皆為正面，而民主程序的評價又優於後者。然而，相互理解的功能評價再高，卻未對實質回應性產生顯著影響。三、是否具有健保會席次並不影響回應性評估；但直接與會者以及實際參與愈積極者，卻反而對委員會回應利害關係人需求的能力抱持較悲觀的看法。最後，在程序面和實質面評價上最為顯著的因素為會議影響力，會議影響力愈大的團體，其回應性也就愈高。 總結上述來回答核心問題：參與是否會提高利害關係人的回應性？在極大化個體利益的動機下，參與制度和行為都只提供爭取權益的機會，不必然導致實質利益。再加上負擔參與成本以及競爭資源的政治現實，參與者進入體制後，反而對委員會的政策回應能力持質疑的態度。是故，會議影響力為關鍵因素，只有在參與過程中獲利愈多者，其回應性才有直接的正面作用；若忽略參與途徑和結果的連結以及權力互動，就過度簡化了參與的政治本質。基於此，行政管理者掌握了決策結構與行政資源，若想取得較佳的回應性評價，就必須在制度和過程面中平衡不同的社會力量，才能使委員會發揮多元參與的功能，而不只是優勢團體的工具。 / Governmental committees are a kind of public participatory mechanism, whereby policy stakeholders are incorporated in the decision making procedure and negotiate with each other to policy outcomes. This mechanism accords with the expectations of both society and government and is frequently used by executive branches all over the world. Ideally, social representativeness can strengthen legitimacy and thereby increase responsiveness. However, in practice, there have also been some criticisms of the committee mechanism, including black box decision making, conflict enlargement, and administrative manipulation. To response this debate, my study addresses whether this type of public participation is responsive to policy demands as well as how to substantially evaluate its effectiveness. Theoretically, participation has a positive impact on policy demands, I provide more precise analysis using the concepts of representativeness and responsiveness. The former refers to how interests are presented in the decision making process, including in both the formal and substantive dimension. The latter refers to the committee’s ability to respond to procedural and substantive demands from society. To illustrate the theoretical framework, the National Health Insurance Committee (NHIC) in Taiwan is taken as my case study. The empirical section is divided into two parts, Fist, I explore original guiding values and institutional design of five committees that emerged under different political-social contexts in Japan, South Korea, Canada, Germany and Taiwan. Based on the results of this comparison, the NHIC in Taiwan is my main topic in the second part. The participatory behavior of committee members and their evaluation of the NHIC system are discussed through the various research methods, such as interviews, focus groups, stakeholder surveys, and also context analysis of meeting minutes. Four results of the study are illustrated as follows: 1. Because the legitimacy of the committee mechanism is empowered by traditional representative authority (the elected legislative or executive branch), it serves a supplementary rather than substitutive function to the existing system. Especially in Taiwan, the administration prefers the advantaged groups more capable of mobilizing social supports over the vulnerable groups which may bring the values of social solidarity and justice into the decision-making of the committee. 2. Stakeholders positively appraised the NHIC’s responsive capacity, both in the procedural and substantive dimensions, with the former appraised more highly than the latter. However, a high level of communication functions had no impact on responsiveness. 3. The institutional variable has no impact on responsiveness. However, direct participation in meetings was associated with more pessimistic views of the NHIC when compared to the non-participators. In addition, the more actors were involved in the NHIC, the more negative their evaluations were. 4. The most significant variable for responsiveness is the decision influence of stakeholders. Does participation strengthen stakeholders’ responsiveness? Under the condition that individuals are motivated by interest maximization, while institutional design and participatory behavior seek to pursue individual interest, it may not always realize substantial benefits. Furthermore, after becoming institutional insiders, the costs of participation and the political reality of power competition will make stakeholders more skeptical about the responsiveness of committee mechanisms. In other words, whether participation can increase the stakeholders’ satisfaction mainly depends on the benefit they can obtain from it. Without taking into account the link between participatory approaches and results, as well as the interaction between various stakeholders, we cannot gain a full picture of the nature of policy participation. In terms of practical reforms, to increase performance responsiveness, administrators who control the structures and resources of the NHIC should incorporate different social forces and interests on the input and process dimensions. This will enable the committee mechanism to perform the function of pluralistic participation, rather than simply serving as a political tool for advantaged groups.

我國全民健康保險政策是屬於社會保險，早期在推行健保時決策模式是傾向國家主義，然而隨著民主化時代的來臨，人民權利意識抬頭，各種利害關係團體相應而生，因此民主治理變成重要的課題。在重要政策參與中各個利害關係人皆希望能夠被納入決策。我國目前健保政策體制內的參與管道最主要為費用協定委員會及監理委員會，主要監督及決定健保預算分配，這兩會在2013年整併為健保會。不論整併前後，委員會基本上是以統合主義的精神運作，邀進行決議，最大的優點在於能夠藉由與多方政策利害關係人的溝通，凝聚社會共識。然而哪些團體能夠代表參與政府制定決策的過程，參與的代表能否充分表達團體的意見？因此代表性正是統合主義中最具爭議的，故如何找出遴選團體的標準是刻不容緩的。 　　本文嘗試以社會統合主義的觀點，套用在健保會運作上。然而社會統合主義要運作的良好，基本上必須要在水平及垂直方面的機制建構完善，垂直層面必須要各級組織匯集各級團體的意見，並由代表進入水平的平臺進行協商；而在水平溝通平臺上也需要各方代表皆能有平等及有效的決策。本文最主要了解的是垂直面的整合情形，亦即這些被派入健保會的政策利害關係團體代表是否有充分的被賦權，在會中討論的結果能否充分落實，因此要衡量團體內部本身的治理。本文欲透過專家座談建構組織內部運作的指標，建構指標測量健保會內部實際運作情況，對於好的健保會參與組織建構初探性的評估。希望未來能夠作為健保會遴選組織進入委員會的參考依據。 / National Health Insurance (NHI) policy is a part of social insurance in Taiwan. In the early stages of the program, the pattern of decision-making tended to be based on a Statist model, but as Taiwan democratizes, citizens and various interest groups have become increasingly aware of their rights. Therefore, the democratic governance of National Health Insurance policy has also become an important issue, as stakeholder groups all hope to be included in the NHI’s decision making process. In Taiwan, the two main participation channels within the system are the Medical Expenditure Negotiation Committee and the Supervisory Committee. The main missions of these two committees are to control health care costs and to allocate medical resources. In 2013, these two committees were merged to form a single National Health Insurance Committee. Whichever their merger status is, the committees basically function according to the principles of Corporatism, whereby peak-level organizations are invited to take part of the committee’s decision-making processes. The biggest advantage of the merger is that the committee would be able to achieve social cohe-sion and consensus through its direct communication with various policy stakeholder groups. But the problem with this arrangement is the following: Which groups can participate in the government’s decision-making process? Can the representatives fully express the views of their respective groups inside the committee? Therefore, the question of representation is the most controversial issue in Corporatist theory, and it is imperative to develop the proper criteria by which major interest or corporatist groups are selected. This study attempts to observe the National Health Insurance Committee from the perspective of social corporatism. For social corporatism to function well in society, basically both its horizontal and vertical mechanisms have to work perfectly. Vertically, groups must be able to amass and integrate the views of their sub-organizations at all levels; horizontally, the group’s representatives must all have equal capacity to make effective decisions. This paper will focus on understanding the vertical dimension of social corporatism, which means asking the following questions: Can/do the representatives fully and adequately represent their group? And whether the outcomes discussed at the committee meetings are fully implemented? To answer these questions it is thereby necessary to measure the internal governance of the groups themselves. This paper will examine various internal operating indicators developed through experts’ panel discussions, with the primary objective of determining good committee participation measures. It is hoped that the construction of these internal governance indicators will serve as the criteria by which future corporatist groups or stakeholder organizations are selected into the National Health Insurance Committee