地方政府衛生與社會行政部門執行長期照顧十年計畫—社會學制度論觀點之探討

A study of the implementation of “10-Year Long-term Care Program” by health bureau and social affairs bureau of local government: the sociological institutionalism perspective

李彥蓉(Yen-Jung Lee)

指導教授 ： 陳武宗

高雄醫學大學/健康科學院/醫學社會學與社會工作學研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00169

摘要

在1993年台灣進入人口高齡化國家，長期照顧即成為重要議題，直到2007年行政院推動「我國長期照顧十年計畫—大溫暖社會福利套案之旗艦計畫」（簡稱「長照十年」）。本研究以社會學制度論為分析觀點，透過深度訪談瞭解14位地方社衛政人員（共6個縣市）在執行長照十年的接受、詮釋、創造協商和社會化、懲罰等內涵，有三個研究目的：一、地方衛政與社政部門執行長照十年的制度化過程；二、在長照十年制度之下，地方衛政與社政部門之交流經驗與感受；三、根據研究結果提出未來政策制定和政策執行時，持續推動長期照顧制度之參考。
研究結論為：一、地方社衛政部門的改變展現於組織、人力和服務等三大層面；二、地方社衛政部門之交流過程出現如魚得水、穩紮穩打、風微浪靜、漸入佳境、靜如止水等五種樣貌；三、地方社衛政部門獲得社會化的回應有限，並透過考核標準和懲罰內涵形塑負向規範；四、長照十年受到制度存在的環境影響；五、制度交流的重要資源—人力支持與執行經費；六、制度創造行動者位置—長照中心成員的影響；七、制度設計補助標準的巧妙平衡；八、成功落實長照十年的行動策略。最後，依據研究結論提出相關討論議題和未來建議。

關鍵字

長期照顧十年計畫 ； 衛政與社政 ； 社會學制度論 ； 制度化過程

並列摘要

As transforming to an aging nation in 1993, long-term care became an important issue in Taiwan. It was not until 2007 that “10-Year Long-Term Care Program - Great Warmth Project” was launched by Executive Yuan (called “10-Years Long-term Care Program”). The sociological institutionalism perspective study analyzed and had in-depth interviews with 14 officers of health bureau and social affairs bureau of local government (total six counties) about the conception of imposition, interpretation, negotiation, socialization and sanctions within the implementation process. Three purposes of the study were: firstly, is to construct the implementation of the institutionalization process by health bureau and social affairs bureau of local government. Secondly, is to understand the experiences and feelings of interaction between health bureau and social affairs bureau of local government in the program. Finally, providing a consultation for the future policy-making and policy-executing which was based on the conclusions.
The conclusions were: firstly, the changes appeared the approach of organizations, human resource and services. Secondly, “reciprocity”, “steadily-process”, “occasional disputes”, “getting better condition” and “frozen interaction” were five types that occurred in the experiences and feelings of interaction between health bureau and social affairs bureau of local government. Thirdly, the feedback that the local government got was limited. Besides, the target-checking evaluation and punishment set by the cancel government led the program shape a negative image. Fourthly, the program was effected with the different intuitional environment. Fifthly, human resources and funding were the important resources of system exchanges. Sixthly, the impact of members of long-term care management center was created on the program. Seventhly, is to find out an unexpected balance between specified and self-payment amount of the program. Finally, is to establish the strategies of process on successful implementation of the program. It introduced issues for discussion and suggestion base on the conclusions.

並列關鍵字

10-Year Long-term Care Program ； health bureau and social affairs bureau ； Sociological Institutionalism ； the institutionalization process.

參考文獻

一、 中文部分

內政部、衛生署與勞委會（2009）。我國長期照顧十年計畫—97至100年中程計畫。內政部社會司網站，http://sowf.moi.gov.tw/newpage/。2010/3/25。

內政部社會司老人福利網站，http://sowf.moi.gov.tw/04/new04.asp。2010/6/18。

王佳煌、潘中道、郭俊賢與黃瑋瑩（譯）（2002）。當代社會研究法：質化與量化途徑。台北：學富文化出版。（Neuman, W. L., 2000）

王增勇（2005）。社區照顧的再省思：小型化？規格化？產業化？台灣社會研究季刊，59，91-141。