| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 89 === The Global Budget Payment System (GBPS) of National Health Insurance (NHI), which was designed based on participatory democracy, has first been implemented in ambulatory dental care in 1998. During the planning stage, from 1995 to 1998, the National Dental Association (NDA) of R.O.C., one of the key players of GBPS, has faced with many obstacles and has managed to solve most of them successfully. Therefore, their experience is valuable to other medical professional groups.
The purposes of this research were to explore the following questions:
1. Why were dentists willing to implement the GBPS? Was it related to their previous experience of the interaction with the State or the health insurance system?
2. What kinds of efforts have the NDA made to reach consensus and to implement the GBPS successfully?
To answer the questions mentioned above, a multi-method-qualitative research was conducted. Data were collected based on the analysis of historical documents (e.g. China Dental Magazine: Journal of the NDA, Dental Bridge: Journal of the Alumni of Dental School of the Taipei Medical College, the official documents of Department of Health, etc.), and in depth interview with key dentists who were the major planners of GBPS. Theoretical sampling and data analysis were applied simultaneously based on Grounded Theory.
Major factors which led the dentists to implement GBPS were as follows: historical context of the State/health insurance system, the efforts to achieve professionalism and the shaping of the organizational culture of the dental association, competing for resources with physician and dental technicians, egoistic and altruistic characters of the dentists’, effective communication among the dentists, and the establishment of a strong working team. Some of the factors mentioned did not arise from the planning stage of GBPS, but accumulated from the historical context. The motivation to implement GBPS came from the expectation that the GBPS may solve some of their long-term problems. In their previous experience, to react with the intervention of the State/health insurance system, three major experience, naming the fighting with dental technicians regarding the professionalism, the operation of the alumni association, and the promotion of oral health, were found to be very important to shape the organizational culture of the dentists’ and to pursue professionalism. Those experiences had led the dentists’ to develop group solidarity and to establish a strong working team to solve collective problems. The development of an effective communication method or the build-up of the consensus mechanism also played a crucial role leading to the success of the NDA. Our observation showed that the implementation of the GBPS not only realized the democrat participation principle of the National Health Insurance Law, it also enhanced the democracy of the NDA.
Based on the results of this study, a few suggestions were proposed:
1. The government should establish a long-term and mutual-trust communication mechanism with the medical professional groups and to empower them to establish the democrat participatory model.
2. Regarding public policy, the medical professional groups should build up effective communication network /mechanism among themselves, and to strengthen their analytical ability to prepare themselves to be the elites who lead the decision making of the public policy. Besides, the professional group should pay attention to the environmental changes, to be able to pick the optimal time to influence policy.
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