國軍退除役官兵輔導委員會長期照護之醫養合一政策執行評估之研究

Evaluation of the Medical Care and Home Care Integration Policy Implemented in the Veterans Affairs Commission, Executive Yuan

王國能(Kuo-Neng Wang)

指導教授 ： 張世賢

國立臺北大學/公共事務學院/公共行政暨政策學系/碩士(2011年)

摘要

論文題目：國軍退除役官兵輔導委員會長期照護之醫養合一政策執行評估之研究 論文頁數：204
所　組　別：公共行政暨政策學系(所)　組 （學號： 79772928 ）
研　究　生： 王 國 能　　　　　指導教授： 張 世 賢 博士
論文提要內容：
本研究之目的主要在探討行政院國軍退除役官兵輔導委員會(以下簡稱退輔會)對推動長期照護「醫養合一」政策，規劃醫療及安養等體系在組織調整、資源整合、服務傳送執行情形，和可能遭遇的問題與限制進行政策評估分析。過去國內外學者對於長期照護之研究多著重於醫療、社會福利及健保財務上，較缺乏針對退輔會體系年老榮民長期照護政策相關研究。是故，本研究綜合相關之研究文獻，探討退輔會長期照護「醫養合一」政策執行可能遭遇的問題與限制，加以分析提供具體實際的政策建議，作為政策延續或修正的參考。本研究係以政策執行評估理論為基礎，以組織調整與發展、資源整合與運用及服務網絡與傳送等三面向，為作分析架構，探討退輔會長期照護醫養合一政策方案。本研究採質性的研究方法，先以文獻回顧輔以現況分析的方式，研究退輔會長期照護「醫養合一」執行所遭遇的問題，針對政策規劃單位、政策執行機構及受照護者等相關人員進行深度訪談，經由歸納、分析及驗證，本研究發現：(一)組織調整並未整合衛政與社政體系，權責不清，事權未統一；(二) 醫養合一政策對榮民長期照護有實質助益，惟相關利害關係人對組織調整、整合醫療和安養（護）資源及服務傳送等方面仍欠缺瞭解；(三) 醫療、安養的專業人力配置不足，且人員調配成為急需處理的問題；(四) 榮家住民就診量尚不足以與榮院支援之醫事人、物力達到效益平衡，且無法負擔長期照護費用；(五)醫療整合法制作業，未能配合政府改造期程。根據上述發現，歸結出下列建議：(一) 確認組織定位，配合完成法制作業，統一事權；(二) 建置長期照護單一窗口，整合醫療及養護資源，賡續推動榮家資源共享；(三) 因應未來長期照護需求，及早培育與配置足夠的服務專業人力；(四) 提升醫療與安養品質，增強榮民(眷)及一般民眾滿意度，以廣收財源；(五)長期照護「醫養合一」政策仍需加強宣導。
關鍵詞：長期照護、醫養合一、政策執行評估

關鍵字

長期照護 ； 醫養合一 ； 政策執行評估

並列摘要

ABSTRACT
Evaluation of the Medical Care and Home Care Integration Policy Implemented in the Veterans Affairs Commission, Executive Yuan
by
WANG, KUO-NENG
January 2011
ADVISOR (S): Dr. CHANG, SHIH-HSIEN
DEPARTMENT: PUBLIC ADMINISTRATION AND POLICY
MAJOR：PUBLIC ADMINISTRATION
DEGREE: MASTER OF PUBLIC ADMINISTRATION
The study attempts to investigate the evaluation of the medical care and home care integration policy implemented in the Veterans Affairs Commission, Executive Yuan (hereinafter referred to as VAC), especially in organization adjustment, resource integration, service delivery, possible questions and limitation etc. Past studies were focused on medical care, social welfare and finance of social welfare; however, it didn’t take long term care for veteran advocated by the VAC into consideration. Thus, the study focuses on the possible problems and limitations arose in the medical care and home care integration policy based on literature review, offering practical treatments for policy adjustment and references.
The study employs the theory of policy implementation evaluation, with the dimensions of organization adjustment and development, resource integration and application, as well as service network and delivery for the medical care and home care integration policy in the VAC. Qualitative analysis was employed to examine the situation of possible problems of the medical care and home care integration policy in the VAC, interview with staff in relevant organizations and people who being cared through the process of induction, analysis and verification. The study findings show that (1) the organization adjustment didn’t integrate the sanitation system of social administrative system so that authority and responsibility were mix up and power didn’t be united. (2) The medical care and home care integration policy in the VAC is good for veterans in the long term, but the interested parties still lack for the understanding of organization adjustment, medical care and home care integration, as well as service delivery. (3) Inadequate staffing for medical care and home care integration become the rush problem currently. (4) Insufficient treatment for veterans can’t balance the personnel expense to cope with long term care. (5) The rulemaking of medical care and home care integration fail to meet the government reform process.
According to the research findings, the suggestions are proposed that (1) organizational position and rulemaking process need to be completed under power united. (2) It is necessary to establish a single window for long-term care, and the medical care and home care integration resource to share the veteran’s resources. (3) Early cultivate sufficient medical care staff to cope with need of long-term care. (4) To increase satisfaction of veteran and the public by promoting the quality of medical treatment and nursing. (5) The medical care and home care integration policy in the VAC need to advocate more and more.

Keywords: long-term care, medical care and home care integration, policy implementation evaluation

並列關鍵字

long-term care ； medical care and home care integration ； policy implementation evaluation

參考文獻

呂寶靜，2005，〈支持家庭照顧者的長期照護政策之構思〉，《國家政策季刊》，4(4)：25-40。

林政逸，2005，〈從政策執行的觀點思考如何提高教育執行力〉，《學校行政雙月刊》，37： 36-45。

林昭吟、劉宜君，2008，長期照顧財務制度之政策預評估-政策學習觀點的初探〉，《臺灣社會福利學刊》，6(2)：61-107。

吳淑瓊、江東亮，1995，〈臺灣地區長期照護的問題與對策〉，《中華衛生雜誌》，14:246-255。

吳淑瓊、莊坤洋，2001，〈在地老化：台灣二十一世紀長期照護的政策方向〉，《台灣衛誌》，20(3)：192-201。