台灣機構式長期照顧服務組織屬性與政府相關政策演變之探討

高齡化社會中，老人對於社會照顧之需求遽增，如何滿足與日俱增的照顧服務量即成爲各國照顧政策探討的重點，各國採取的回應策略之一即是開放營利事業組織加入服務提供行列。我國在老人福利法於1997年修法後特許營利事業進入小型機構服務範疇，但行政院衛生署主管的護理之家並未被要求需辦理財團人登記；究竟長期照顧相關服務之提供上，公部門在長期照顧體系的規劃以及政策法令建構過程中到底扮演了什麼角色，而服務提供者之組織屬性是「營利」或「非營利」在服務品質、案主權益的關照、經營效率與成本等面向是否有所差別，乃是本研究關注的焦點。據此，本研究參考Antonin Wagner建構的公共服務領域之結構轉變(structural transformation of the Public sphere)理論觀點，分析台灣長期照顧服務組織屬性與政府的政策互動關係。本研究運用次級資料分析法，分析內政部社會司主管的老人福利機構屬性及家數在老人福利法第一次修法前後之變動趨勢，以及行政院衛生署主管的護理之家變動之趨勢，並輔以深度訪談法，訪談中央及地方老人福利機構及護理之家主管機關，以及老人福利機構及護理之家經營者等人，從「時間」(time)與「轉變」(transformation)兩個面向觀察台灣長期照顧服務提供的形貌、變化及其原因，進而對我國長期照護相關政策與法令規範提出政策建言。

關鍵字

長期照顧；非營利；營利；財團法人；護理之家

並列摘要

There is a significant increase in the demand of social care service for the aging population in modern society. As a result, it has become a major focus for the government to create or revise policies with respect to both of the quantity and quality of the institutional are. After passing the first amendment of the Senior Citizens Welfare Ac in Taiwan, it allows long-term care institutions to be operated as for-profit entities. However, the same regulation was not applied to nursing homes whose operations are in the jurisdiction of the Department of Health the Executive Yuan. This article analyzes mainly the intra-governmental and government-private (nonprofit and for-profit) relationships in the area of long-term care service providers for the elderly, which is based on the analytical framework of structural transformation of the public sp ere proposed by Antonin Wagner (2000). The focus of this paper, as a consequence, is to explain how and why the long-term care system in Taiwan has been changed since the late 1990s by examining both aspects of time and transformation. The secondary data analysis was used to investigate the profile of the senior citizens welfare institutions and nursing home in Taiwan in terms of their characteristics and the transformation in their number since 1997. The method of ”in-depth interview” was then adopted to assemble key information from managers of the institutions, as well as public officers.