2012-11-27 為什麼要辦二代健保說明會？

為了瀕臨破產的健保，二代健保又將倉促上路，不管醫療人員有何反對的聲音，短時間都很難影響到政策的內容吧。官員們到底為什麼要一直找醫療人員假惺惺地說明二代健保的好處呢？

如果從二代健保的推行來看，健保局官員就是握有實權的領導者，而醫療人員就是下屬般的角色。所以，從管理學裡面的領導部分來思考就可以瞭解其背後的用心了(？)。

領導(leadership)是指影響某個群體的成員，使之願意努力達成群體目標的過程。優秀的領導者可以讓群體成員同心協力，為了達成共同目標而努力奮鬥。各種領導理論各有其長處，其中由Victor H. Vroom與Phillip Yetton所提出的領導者參與模式(Leader-participation model)是主張考慮各種可能的影響因素，再決定應該採納何種領導型態。

領導型態主要分為五種：

1.       Autocratic Type 1 (AI) – Leader makes own decision using information that is readily available to you at the time. This type is completely autocratic.
專制1─讓領導者依手上現有的資料自行做決定。

2.       Autocratic Type 2 (AII) – Leader collects required information from followers, then makes decision alone. Problem or decision may or may not be informed to followers. Here, followers involvement is just providing information.
專制2─領導者也是自行做決定，但會從下屬獲得必要的信息。在決策中下屬的任務是向你提供必要信息而不是提出或評估可行性解決方案。

3.       Consultative Type 1 (CI) – Leader shares problem to relevant followers individually and seeks their ideas & suggestions and makes decision alone. Here followers’ do not meet each other & leader’s decision may or may not has followers influence. So, here followers involvement is at the level of providing alternatives individually.
個別諮商─領導者徵詢下屬的意見。所作出的決策可能受到或不受下屬的影響。

4.       Consultative Type 2 (CII) – Leader shares problem to relevant followers as a group and seeks their ideas & suggestions and makes decision alone. Here followers’ meet each other and through discussions they understand other alternatives. But leader’s decision may or may not has followers influence. So, here followers involvement is at the level of helping as a group in decision-making.
群體諮商─領導者集體向下屬說明問題並聽取意見。所作出的決策可能受到或不受下屬的影響。

5.       Group-based Type 2(GII) – Leader discuss problem & situation with followers as a group and seeks their ideas & suggestions through brainstroming. Leader accepts any decision & do not try to force his idea. Decision accepted by the group is the final one.
授權─領導者在既定範圍內由群體成員說明問題後協助成員獲得一致的解決辦法。

根據以下的樹狀圖，依序回答七個影響因素的問題，就可以得到建議的領導型態。

我們嘗試依照領導者參與模式(Leader-participation model)來回答問題的話：

1.          Is there a quality requirement? Is the nature of the solution critical? Are there technical or rational grounds for selecting among possible solutions?
質量要求：這一決策的技術質量是否重要？
Yes：二代健保非常複雜，搞得人心惶惶，所以質量明顯很高。

2.          Do I have sufficient information to make a high quality decision?
領導者的信息：領導者是否擁有充分的信息做出高質量的決策？
No：健保局的官員往往都不了解第一線醫療人員面對問題的全貌。

3.          Is the problem structured? Are the alternative courses of action and methods for their evaluation known?
問題結構：問題是否結構清晰？
Yes：二代健保雖然複雜，但是大致上的內容都已確立。

4.          Is acceptance of the decision by subordinates critical to its implementation?
承諾要求：下屬對這一決策的承諾是否重要？
Yes：醫療人員需要乖乖聽話，不要反抗，二代健保才能順利推行。

5.          If I were to make the decision by myself, is it reasonably certain that it would be accepted by my subordinates?
承諾的可能性：如果是你自己做決策，下屬是否一定會對該決策做出承諾？
No：醫療人員對於裡面很多改革方式都是幹在心中口難開。

6.          Do subordinates share the organizational goals to be obtained in solving this problem?
目標一致性：對於解決問題，下屬是否有相同的目標？
No：醫療人員的目標明顯和唱高調的健保局官員不同，多數人希望政策越簡單越好，不希望搞得很複雜，申報變得超麻煩，官員很閒，但是民眾很忙。

7.          Is conflict among subordinates likely in obtaining the preferred solution?
下屬的衝突：下屬之間對於優選的決策是否會發生衝突？
Yes：二代健保爭取的額外經費，並沒有明顯幫助醫療人員增加待遇，反而可能藉由煽情的媒體，來把民眾的怒火轉嫁到無辜的醫療人員身上。

最後可以發現樹狀圖走向群體諮商。因此，健保局必須苦口婆心、半哄半騙地和一群醫療人員說明才是最好的方式來鎮壓減少反對的聲音。而不是採用專制或是和少數大老說明就可以了事的。

 參考資料：
1. Leadership Champions

2. 健保局