社區照顧服務輸送模式之探討

Exploring Service Delivery Models of Community Care

黃源協(Yuan-Shie Hwang)

《社會政策與社會工作學刊》 4卷2期 (2000/12) Pp. 179-220

https://doi.org/10.6785/SPSW.200012.0179

摘要

本文旨在以英國社區照顧發展經驗爲基礎，嘗試探討英國社區照顧服務輸送的不同模式，及其對起步中的台灣社區照顧之意涵。1940年代中期福利國家的建立，將英國帶進了一個以科層結構和專業主義掛帥之「科層－專業主義體制」服務輸送模式，儘管服務的範疇擴充了，但其父權主義和缺乏效率的事實，在1970年代中期已招致嚴厲的批判。1980年代以來，一種強調績效、結果和顧客爲主的新管理主義理念，要新右派人士的極力倡導下，在實務上已逐漸取代科層－專業主義的模式。然而，新管理主義之過度強調經濟、效率與效能，而忽略人群服務對公平與倫的訴求，卻使得新管理主義和科層－專業主義間産生爭辯。爲能兼顧新管理主義對福利服務資源之有效運用的訴求，以及科層－專業主義對公平和倫理的考量，一種緩和兩者間爭辯的新思維，且建立在「最佳價值」基礎上的「新專業－新管理」模式，其強調以調解、參與和共事，並著重於對專業自主權的尊重和管理之務實的作爲，或許是化解科層－專業主義與新管理主義對峙的良方。台灣的社區照顧正值起步階段，爲避免因過度走向虛無理想的新管理主義，或陷於無效率和昂貴的科層－專業主義，這種朝響「新專業－新管理」模式的發展。或許可作爲建構一個兼顧「專業」、「管理」和「顧客取向」之台灣社區照顧體系的重要借鏡。

關鍵字

社區照顧 ； 科層－專業主義 ； 新管理主義 ； 新專業－新管理

並列摘要

This paper, based on the experiences of community care development in Britain, aims at exploring different models of community care management, and concluding its implications for the development of community care in Taiwan. The creation of welfare state brought the British welfare service delivery into a 'bureau-professionalism regime' model in the mid-1940s. Its category expanded but caused severe criticism as a result of its paternalism and inefficiency in the mid-1970s. The idea of new managerialism which emphasizes performance, outcome and customer-oriented has increasingly replaced the traditional 'bureau-professionalism' model practically under the advocacy of the New Right since the 1980s. Because the former over-emphasizes economy, efficiency and effectiveness and ignores equity and ethics which human services appeal, a controversy between bureau-professionalism and new managerialism has therefore provoked. This paper proposed a new professional-new management model based on a new idea of 'the best value' as a strategy for pacifying the dispute. Further, through its adherence to mediation, patronage and collegiality and through its tolerance of both professional autonomy and management, the model will be able to re-establish equilibrium in the caring services. In Taiwan, community care is in its initial stage. To avoid getting into an empty rhetorical new management or drawing into an inefficient bureau-professionalism, the new professional-new management model may provide us a speculative direction of constructing an appropriate community care system.

並列關鍵字

community care ； bureau-professionalism ； new managerialism ； new professional-new management

參考文獻

(1993).Quasi-market and Social Policy.London:Macmillan.

Abbott, P., Meerabeau, L.(1998).The Sociology of the Caring Professions.London:UCL Press.

Brechin, A.(2000).Critical Practice in Health and Social Care.London:SAGE.

Butcher, T.(2000).Changing Practice in Health and Social Care.London:SAGE.

Causer, G., Exworthy, M.(1999).Professionals and the New Managerialism in the Public Sector.Buckingham:Open University Press.