知識經略：以我國中央健康保險局的知識創造機制為例

Abstract

我國的全民健康保險，在眾人皆不看好的情況下，從篳路藍縷以至於小康，其中健保局的角色應為關鍵。健保制度在巨觀的意義上，與其他實施社會保險國家的制度雖具有共同的特徵，但是在實踐的層次上，卻有無從借鏡之苦。健保局在各界質疑、民眾需求多樣、且無前例可遵循的情況下，開辦初期，難免左支右絀。但是，經過一段時間的摸索，逐漸從實踐中發現一些要領。本文從實地訪談的結果，發現：健保局的知識創新與經略，符合文獻中知識經濟機構的諸多原理，例如：內隱知識與外顯知識之間的互相啟發、激勵；分局之間的知性互動機制的多元與順暢，且進行「非零合」的競爭；在眾多監督單位的注意下，員工努力從實做中學習等，均為健保作為知識經濟機構的初始原因。領導者刻意製造「創造性混亂」，以保持員工的動能；員工在相對較優的激勵下，積極創造新措施，因此能在不知不覺當中創造知識，並使健保能在艱難環境中逐步開展。

Few people made optimistic predictions when the national health insurance（NHI）was just implemented. To the surprise of many, the NHI program survived several crises and seems to stand firm, despite it faces a wide spectrum of difficulties. We believe that the Bureau of NHI must have done something right. Taiwan’s NHI might seem similar in its rough contour with those in advanced countries, there is really no reference when it comes to the details of implementation. The Bureau of course had a hard time at its nascent stage under the pressure of unsatiated demand from the public, hostility from the medical profession, and ubiquitous political interferences. The Bureau, after a period of chaos, was able to pull off and put itself on the track. Drawing on the procedures of grounded theory and using what we call “recursive focus-group discussion session”, we found that, the economy of knowledge on the part of the Bureau was inline with a number of the sound principles in the literature of knowledge creation in an organization. In particular, the interaction between the tacit and explicit knowledge has contributed to a great deal of knowledge creation of the Bureau; non-zero-sum competition among the branches was conducive to sharing of newly created knowledge. Besides, a multitude of the supervisors leaves no room for the Bureau to make mistakes. The “creative chaos” intentionally created by the upper echelon also headed off any demoralizing factors and has kept the staffs creative.