契約關係下非營利組織與地方政府夥伴關係的探討—以長照2.0巷弄長照站為例

巷弄長照站為長照2.0社區整體照顧模式中新穎的制度設計，尤其2018年希冀透過簽訂「特約契約」，以「重新定位」與民間長照服務單位的合作關係，顯示在方案補助計畫與特約制下的巷弄站，契約已成為公私協力的重要媒介。本文旨在聚焦契約關係下，非營利組織的參與能量如何，即探究哪些規範可促進參與誘因，抑或消耗服務量能，進而影響協力動態中共享的動機等，並以夥伴關係角度評估其協力成果與維持夥伴關係的關鍵考量。在研究方法上，本文採強度抽樣，依「資源布建數」、「服務涵蓋率」與「給付支付審核撥付費率」等標準，選擇整體表現良好的桃園市與臺南市為研究地區，並與公部門、民間單位共計13位受訪者進行訪談，以瞭解第一線執行者於2018年的推行經驗。研究結果發現，在共享的願景下，參與者呈現偏好的目標與手段皆略有不同的對立模式。經互動磨合後，在政府同樣嚴格控制財務與法規的情況下，就彼此溝通與接觸程度來說，雖然解決反饋問題的成效有其限制，但溝通往來日趨密切。在協力過程中，地方政府與民間單位實則也不斷調整雙方的任務與期望，就民間單位而言，滾動式修正決策儘管沒有達到十全十美，其實多也願意配合公部門，也取得一定程度的合作默契。惟目前契約提供較薄弱的參與誘因，尤其「補助項目與額度不足」、「未建立暫付機制」與「核銷繁瑣」為未產生誘因相容之處；然而地方政府在平衡「契約彈性」與「監督服務品質」方面，則有利於尚在起步階段的單位投入，也一定程度反映正式與非正式契約的互補有益於夥伴關係鞏固。最後，「資金因素」確實為維持長期夥伴關係的重要誘因，但僅依賴物質誘因無法造成協力的良性循環，或促使非營利組織更高水平的投入，尚要將非物質資源因素的「減少政策修正幅度」、「服務的心態與使命」等納入考量。

關鍵字

夥伴關係；契約管理；長照2.0 ；巷弄長照站

並列摘要

Neighborhood long-term care stations are a novel institutional design in the Long-term Care 2.0 – Comprehensive Community Care model. In particular, since the government hopes to “reposition” the cooperative relationship with the long-term care units in society through signing “authorization contracts” in 2018, it has become evident that contracts have become an important medium in public-private collaboration for the neighborhood stations under the project subsidy scheme and authorization system. This paper aims at the participation capacity of non-profit organizations under contractual relationship, which means investigating what norms can promote their incentives to participate, or consume their servicing capacity, which in turn affects their motivation to share in the dynamics of collaboration. Further, the results of their collaboration and their key considerations in maintaining the partnership will also be assessed from the partnership perspective. With respect to the research method, this paper adopted the method of intensity sampling. Based on the criteria of “number of resource deployments”, “service coverage rate”, and “rate of benefit payments, premium payments, review and appropriation”, Taoyuan City and Tainan City, whose overall performance was the best, were chosen as the research area. In addition, in-depth interviews were conducted with the public sector and non-government units in order to understand the implementation experience of frontline executors. The research results show that under a shared vision, the participants displayed a conflicting mode of having a slight difference between their preferred goals and means. Through interaction and adjustment, under the situation that they are all subject to the same strict government control of their finances and laws and regulations, their communication and contact have gradually grown intimate, even though the effectiveness of feedback still has its limitations. In the process of collaboration, local governments and non-government units in fact also have been continuously adjusting their respective tasks and expectations. To the latter, though the rolling revision of decisions has not been perfect, most of them in fact are willing to coordinate with the public sector, and to some extent have acquired a tacit understanding in cooperation. However, at present, contracts provide weak participation incentives; in particular, “inadequate subsidized projects and amount,” “temporary payment mechanism not established” and “cumbersome write-off procedure” are reasons that incentives have not been created. Yet the effort of local governments in balancing “contract flexibility” and “service quality supervision” is favorable to making input by units still at the initial stage, which also to some extent reflects that the complementation of formal and informal contract is beneficial to the consolidation of their partnership. Finally, “funding factor” is indeed an important factor for maintaining long-term partnership, but simply relying on material incentives can hardly bring about a virtuous cycle of collaboration or motivate non-profit organizations to make higher level of input. It still requires taking such factors of non- material resources as “minimizing the extent of policy revision” and “service mentality and mission” into consideration.