Twelve - Policy network of universal healthcare reform in Taiwan

Summary

Introduction

The structure of governance and management of networks have received increasing attention in recent years with the spread of policy networks aimed at describing policy processes in modern society. It has been argued that it is necessary to understand the internal functioning of networks in order to evaluate how different ties between policy stakeholders produce policy outcomes. Social network analysis (SNA), as a research tool of policy networks, can systematically characterise the power and positions of key players, describing the role stakeholders play in influencing various policy decisions. In addition, SNA adds value by enumerating the linkages between those actors, particularly in terms of how information and political resource are exchanged and who is included or excluded from the process. Moreover, drawing on graph theory and classical sociology (Luke and Harris, 2007), SNA has been widely applied in various public policy disciplines. More and more cases show that if SNA is applied to studying policy networks it can help the understanding of the nature of power pathways and influence in policy processes.

This chapter attempts to shed light on this research area by means of a study of Taiwan's National Health Insurance (NHI) reform between 2004 and 2012. The Taiwan government announced the termination of martial law in 1986, following which Taiwan quickly transformed into a full-fledged democracy (Aspalter, 2002: 4). Thus, the ruling party, Kuomintang, faced a challenge from the opposition party and civil society associations in the late 1980s. In order to cope with these challenges, Kuomintang shifted its attention to the construction of a universal welfare system by integrating the original four insurance systems and expanding coverage from 59% to universal (BNHI, 2007). After more than two decades of democratisation, Taiwan established a universal healthcare system responsible for the welfare of all inhabitants, which has become an important determinant of governmental legitimacy in Taiwan. As some significant research works indicate, healthcare is a social welfare policy, but one that is highly influenced by politics (Weissert and Weissert, 1996; Moran, 1999; Thomas and Gilson, 2004). In Taiwan as well, healthcare is a political issue (Wong, 2003, 2004; Lin et al, 2010; Wang, 2012).

The NHI was designed to include characteristics such as compulsory enrolment, a single public player (Bureau of National Health Insurance, BNHI), and contributions shared by employer, employee and the government.