老人機構照顧民營化：英國、瑞典和香港經驗之比較分析

Privatization of Residential Care for Older People in England, Sweden and Hong Kong: Experiences and Implications for Taiwan.

蕭文高(Wen-Kao Hsiao) ； 黃源協(Yuan-Shie Hwang)

《社會政策與社會工作學刊》 8卷2期 (2004/12) Pp. 83-124

摘要

本研究的目的在藉由比較社會服務的方式，分析英國、瑞典及香港三個個案的老人機構照顧在遭遇民營化的結構壓力時，所採行的因應措施及制度轉變，並回應到台灣現行的脈絡之下，提出對相關政策規劃及制度設計的建議。為達成研究之目的，本文首先就比較社會政策的方法論進行探討，並對社會服務領域的運用進行分析，依據研究主題的特性，以服務輸送及規制結構做為分析主軸，採取結合質性及量化資料的歷史研究方法，分別就三個個案的發展經驗進行檢視。經研究後發現，在英國、瑞典及香港的歷史發展過程中，老人機構照顧的民營化呈現出聚合以及歧異的現象，一方面每個個案均採取部份民營化的策略，但是當服務輸送結構部份轉移給民間部門之際，國家規制結構卻相對地制度化，以提升服務品質，並結合社區照顧、照顧管理或需求評量以進行整體政策規劃；另一方面，在地方政府自主性或社會基礎差異中，亦產生不同的民營化深度以及規制制度的設計。最後，本研究認為台灣應擷取英國、瑞典及香港的發展經驗，在老人機構照顧民營化的政策規劃中，應納入風險管理及總體性規劃的概念，並對現有的規制結構以及區域正義的問題進行思考，再決定未來民營化的走向及深度。

關鍵字

比較社會政策 ； 社會服務 ； 老人機構照顧 ； 民營化

並列摘要

In the way of comparative social services, this study aims to analyze the coping strategies and institutional transitions of residential care for older people in England, Sweden and Hong Kong under the structural pressures of privatization, and provides some implications for policymaking and institutional planning in Taiwan. For the sake of achieving this purpose, the methodologies of comparative social policy were investigated and its applications for social services field were discussed. According to the characteristic of this topic, the historical research method was used, with combining qualitative and quantitative materials, to review the experiences of three cases with focusing on service delivery and regulatory structures. Following a short review of the historical development of policies, both convergence and divergence of privatization in three cases were defined. On the one hand, each country not only carried out privatization strategies and transfered the responsibilities of services delivery to independent sector, but also institutionalized its regulatory structure for enhancing the services quality. On the other hand, variations among countries in privatization and regulatory structures were affected by their local authorities' autonomy and social foundation. Finally, what this study suggests is that Taiwan can learn from England, Sweden and Hong Kong before deciding the direction and depth of privatization, it needs to consider the factors of risk management, integrated planning, regulatory structure design and regional justice.

並列關鍵字

comparative social policy ； social services ； residential care for older people ； privatization

參考文獻

劉淑瓊(2001)。社會服務民營化再探：迷思與現實。社會政策與社會工作學刊。5(2)，7-56。

Chiu, S. W. S.,Wong, V. C. W.(1998).Community Care for Older People in Hong Kong: From Policy to Politics.社會政策與社會工作學刊.2(2),101-137.

Alber, J.(1995).A Framework for the Comparative Study of Social Services.Journal of European Social Policy.5（2）,131-149.

(http://www.ijic.org/publish/articles/000005/index.html/)

Anttonen, A.,Sipila, J.(1996).European Social Care Services: Is It Possible to Identify Models?.Journal of European Social Policy.6（2）,87-100.