本文在新古典學派「結果主治（telocracy)」與海耶克傳統的 「規則主治（nomocracy )」兩種政治經濟哲學的論述比較中，探討我 國全民健保的「改革的制度（institution for reform)」，試圖藉由決策 程序與規則的建立，間接達成合理「制度的改革（reform of the institution)」的結果。將重點置於改革的制度，乃是錯於全民健保的 任何一項改革總是遭遇極大的困境。制度有待改革不是問題，但欠缺 「改革的制度」而無法落實改革，才是問題。 本文先從對若干與公共決策攸關的經濟學論述典範的批判入手，然 後試圖從這些論述典範所無能爲力的地方去尋求落實改革的可能性。 首先，我們指出：福利理論雖然指出可欲的經濟體系的「結 果」，但對於如何達成這樣結果的「過程」，卻未有著墨，且其理性選 擇假設有相當多限制，因而必須有外爍的代理機構；而效用外生化的 假設，也使得改革者（reformists)所能運作的改革槓桿大受限制。政 治經濟學的論述，則將利益團體當作是一個「巨型個人（supra-individual)」，在其中並不探討這樣的巨型個人的學習機制，因此，使 改革成爲各異議團體競逐的場域，雖然可能可以產生「政治解決」的 答案，但往往不能產生合理的改革結果。至於公共選擇理論，則雖與 古典經濟學一樣具有個體基礎，但是也同樣未能分析個體經由學習改 變偏好的可能。 本文勾連了海耶克傳統與現代的政策分析與管理，一方面使前者 在政策分析上具有現實上操作的意義，另一方面也提供後者政治經濟 哲學的基礎。根據這樣的架構，本文提出了我國全民健保決策與治理 體系的具體建議。

Drawing on a comparison between the telocracy-oriented neoclassical economics and the nomocracy-oriented "Hayekian Tadidtion, this article is to search for an “institution for reform’’，in the hope that， through redign of the rule and process to accommodate “democratic learning” in policy making, rational “reform of the institution” can be achived. We believe that, it is not a problem that the national health insurance (NHI) institution needs a reform; it is a problem if there is no appropriate institution for a reasonable reform to take place. The authors appreciate the comments of three anonymous reviewers, and all the remaining errors are solely those of the authors.Our approach is to take issue with three major paradigms in economics: welfare economics, political economy, and public choice theory. After characterizing the loose end left by these theses, we try to find ad hoc “remedies” as a way to tie up the loose ends and make an institution for reform available. We criticize that the assumption of rational choice in welfare economics is often time out of place; and the exogenous preference hindered a possibility for reform. The approach of political economy suggests that the inefficiency is produced as a consequence of the collective action on the part of the interest groups. In our view, public choice theory is successful in de-mystifying several myths in political economy and points to a possibility of reasonable reform based on some ad hoc design. Our conclusions are: the new NHI decision-making and governance institution must be value-laden, must be trustworthy so that this agency can convince the public to change their preference and make a rational reform possible.