福利混合經濟下的社區照顧－英國的經驗、台灣的借鏡

Community Care under the Mixed Economy of Welfare-British Experience, Lessons for Taiwan

黃源協(Yuan-shie Hwang)

《社會政策與社會工作學刊》 2卷1期 (1998/06) Pp. 39-85

https://doi.org/10.6785/SPSW.199806.0039

摘要

八○年代前，英國社會照顧的主要供給者是由政府部門擔負，八○年代後期興起之「照護混合經濟」，促使民間部門之服務提供者的角色迅速擴張。此項改革的主要目的是欲藉由激勵民間部門對服務供給的參與，以創造出需求導向、使用者中心、市場驅使、有效率以及成本抑制的服務輸送體系。為達成目標而採取的主要策略有二：購買者與供給者的分離以及照顧管理的實施。顯然，「照護混合經濟」實施以來，地方政府的角色已逐漸由服務的「供給者」轉變為「使能者」。然而，對實現其所欽追求的目標，在理想與現實間仍有些距離，且各種照護部門也受到不同程度的衝擊。儘管對英國之「照護混合經濟」的改革是否成功尚有爭議，但她的經驗卻可提拱台灣在推展「福利社區化」或「社區照顧」上許多重要的借鏡，特別是其縝密的決策過程、部門間的協調以及資源的整合。

關鍵字

社區照顧 ； 福利混合經濟 ； 照護混合經濟 ； 福利社區化

並列摘要

Prior to the 1980s local authorities in Britain are responsible for providing social care for those who need it. As a result of the development of 'the mixed economy of care' an increasing share of that responsibility has been carried by the rapidly expanding private provision of such care since the late 1980s. By stimulating and involving the private sectors in providing care, the reform is intended to create a service delivery system with needs-led, users-centred, market-driven, efficiency and cost-containment. The goals would be achieved in two main strategies-the split of purchaser and provider, and the introduction of care management. Evidently the role of local authorities' has been increasingly shifted from 'provider' to 'enabler' under the reform. Nevertheless there still have a gap between ideal and reality in achieving its goals and the impacts on public and private sectors are varied. It is still arguable how much the reform has achieved. However there are valuable lessons that we can learn from the British experiences for developing community-based services or community care in Taiwan, in particular its thoughtful policy-making processes, the coordination between sectors and the integration of resources.

並列關鍵字

community care ； mixed economy of welfare ； mixed economy of care ； community-based service

參考文獻

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