老人機構提供醫療服務模式之探討-以桃園地區為例

Explore the Models of Health Services for Persons with Senior Citizens Welfare Organizations and Nursing Home in Taoyuan

陳韻宜(Yun-Yi Chen)

指導教授 ： 陳燕禎教授

元智大學/人文社會學院/社會系/碩士(2008年)

摘要

本研究旨在探討外在環境因素是否會影響桃園地區老人機構提供醫療服務，並以機構提供者角度建構出桃園地區老人機構提供醫療服務之模式。研究方法採用質性研究的深度訪談法，從「生態系統理論」、「制度理論」及「資源依賴理論」，瞭解老人機構提供醫療服務所產生的問題並進一步分析。本研究共完成訪談11家老人機構（含7家老人福利機構和4家護理之家），及完成訪談18位受訪者（10位機構管理者，及8位醫療服務提供者）。
研究重要發現有四點：1.老人機構皆強調「立案與否」是經營之主要條件；機構收容情況多為滿床，且護理人員多為超額編制，社工人員較為缺少或是以合聘、特約的方式聘請。老人福利機構經營模式以家族企業居多，護理之家則以外聘人力服務為主。2.從生態系統理論觀之，位於「郊區」的老人機構傾向選擇醫療需求較低的老人，主要資源提供者為綜合醫院或是診所；「市區」老人機構主要資源提供者則為綜合醫院或是單一專科診所。提供醫療服務主要困難為地區醫療資源分佈不均及受到衛生相關政策（如全民健康保險法、長期照顧十年計畫等）影響。3.以制度理論來看，提供醫療服務的首要衝擊為服務內容之「硬體結構面」，其次為「服務過程面」及「結果呈現面」。4.機構提供醫療服務主要資源來自於醫療機構和公部門機構；在資源依賴程度上，老人福利機構為完全資源依賴，護理之家則為部分資源依賴。桃園地區老人機構提供醫療服務仍受於城鄉分布及資源上的影響，建議政府應建立老人機構醫療服務提供資訊平台，且加強機構對於相關政策法令訊息接收的完整性，以整合桃園地區老人機構醫療服務資源，讓老人機構所提供的醫療服務更具完備。

關鍵字

醫療服務模式 ； 生態系統 ； 資源依賴 ； 制度理論

並列摘要

The thesis aims to discuss whether external factors will influence Senior Citizens Welfare Organizations and Nursing Homes to provide health services, and to construct the model of health services from the perspective of organization providers Based on Ecological Perspective Theory, Institutionalism and Resource Dependency Theory, the research method includes in-depth interviews to probe into and analyze the problems of health service caused by Senior Citizens Welfare Organizations and Nursing Homes. The thesis has interviewed eleven organizations in total, which include seven Senior Citizens Welfare Organizations and four Nursing Homes, and eighteen interviewees, which include ten organization managers and eight health service providers.

There are four important discoveries in the thesis. First, all the Senior Citizens Welfare Organizations and Nursing Homes emphasize legal registration as the essential administrating condition. They take in patients to a full bed and recruit nursing staff above quota. Social workers are inadequate and employed by special arrangements. The administrating model of Senior Citizens Welfare Organizations is mostly family business while that of the nursing homes is mostly manpower from outside. Second, from the perspective of Ecological Perspective Theory, Senior Citizens Welfare Organizations and Nursing Home located in the suburbs tend to prefer elder people of lesser needs. The main resource providers are clinics and polyclinics. The major problems to offer health service are the unproportionate distribution of medical resources in different areas, and the influences from the related policies, such as National Health Insurance. Next, from the perspective of institutionalism, the primary impacts of the health service are structure, process and outcome. Finally, the major providers for medical resources are medical organization and government institutions. In terms of resource dependence, Senior Citizens Welfare Organizations are totally dependent while nursing homes are partially dependent. The health service provided by Senior Citizens Welfare Organizations and Nursing Homes in Taoyuan has its limitations due to the gap between city and suburb and the unequally resourceful distribution. To solve the problem, our government should establish a resource forum for these organization and nursing homes to help them fully receive the information of related policies. Therefore, by combining all the resources in Taoyuan, the health service by these organizations may be more complete.

並列關鍵字

the model of health services ； ecological perspective theory ； institutionalism ； resource dependence theory

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