地方治理與居家服務：比較南投縣與新北市的經驗

Local Governance and Home Care: Comparing the Experience of Nantou County and New Taipei City

覃玉蓉(Yu-Rung Chyn)

指導教授 ： 黃長玲

國立臺灣大學/社會科學院/政治學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.01291

摘要

這是一份關於「地方國家」治理的比較研究，比較的焦點為居家服務──一種在個別家庭中，為需要長期照顧的個人所提供的支持性照顧服務──的地方治理網絡。隨著臺灣從威權體制逐漸民主化，臺灣的人口結構也快速老化。然而，臺灣人民仍大量依賴家庭成員、外籍看護與市面上的機構照顧服務，來回應迅速增加的長期照顧需求。在照顧與經濟負擔日漸沈重、社會不平等逐漸擴大的背景下，輿論要求新興的民主國家積極回應人民的長照需求。中央政府在21世紀初開始透過補助，建置居家服務，但主要的執行責任則在地方政府，以及與地方政府簽約承接居家服務的民間團體。

本研究比較南投縣與新北市的經驗，訪談共4個民間團體以及兩地的居家服務承辦人，輔以政府檔案、新聞報導與統計數據，初步分析地方提供居家服務的基礎結構，並嘗試探索在台灣的制度脈絡下，國家介入以適當回應人民長照需求、減輕人民照顧負擔的可能性與限制。

研究發現南投縣的居家服務治理網絡相對鬆散，且缺乏財源挹注，而新北市政府與民間團體之間的關係，則近似學者Peter Evans所謂的「鑲嵌自主性」。這兩個地方治理體系分別能在多大程度上回應人民的長照需求，尚待進一步研究。然而，目前已經可以看出，兩個縣市皆面臨照顧勞動者短缺的問題，加以其他研究指出，居家服務整體的治理結構傾向排除以社區為基礎、更加使用者導向的組織型態，這些情況將限縮居家服務未來進一步發展的機會，並限制中央及地方政府回應人民長照需求的能力。充足的財源必須補足，但是僅僅如此尚不能解決問題。我們需要能夠含括更多方參與者的治理網絡，以及奠基於平等關係上的協力模式，整個社會回應人民照顧需求、緩和照顧負擔的能力才可能強化，而這樣的民主治理如何可能實現，亦亟待進一步研究。

關鍵字

地方治理 ； 居家服務 ； 長期照顧 ； 南投縣 ； 新北市 ； 國家介入 ； 地方國家

並列摘要

This is a comparative study of the ‘local state’ governance in Taiwan. The focus of comparison is on the local governing structure of home care, a supportive care service provided in personal residence for people requiring long-term care. As Taiwan transits from an authoritarian regime to a democratic one, its population is aging fast. People depend largely on family members, foreign workers and institutions in the market to meet their caring needs. With caring and financial burden growing, along with social inequalities widening, the public demand that the newly democratized state respond to people’s caring needs. The central government started to finance and to develop home care service at the beginning of 21th century, while the implementation is left to the local governments and the social organizations with whom the central government makes contract.

This research compares the experiences of Nantou County and that of New Taipei City through interviewing four social organizations providing home care services and local officials who are responsible for developing home care in these two areas. This study also relies on qualitative evidence from government documents, newspaper articles and statistical data as references. What this research provides is a preliminary analysis of the local infrastructure of home care, the local governing networks that run the most prevailed ‘public long-term care service’ in Taiwan. Moreover, it tries to search for the possibilities and the limits of state involvement in soothing people’s caring burden and ensuring that adequate care is provided to those who are in need within Taiwan’s institutional context.

The finding shows that Nantou County has a relatively loose governing network and suffers more from the lack of finances, while the interface between social organizations and the local government in New Taipei City shows patterns close to what Evans calls "embedded autonomy." How much caring need these two local infrastructures can adequately respond to requires more future researches. For now, these two areas both suffer from severe labor shortage for caring, and the governing structure is not very supportive of community-based or more user-empowering way to deliver home care service, which may threaten further development of home care service and gravely limit local and central governments’ capacity to respond to people’s urging long-term care needs. A sufficient finance is needed, but is far from enough. A more inclusive governing network and a collaboration based on an equal basis are also necessary for strengthening the society’s capacity of responding to people’s long-term care needs and alleviating their caring burdens. How the difficult task of democratic governance can be tackled needs further research urgently.

並列關鍵字

local governance ； home care ； long-term care ； Nantou County ； New Taipei City ； state involvement ； local state

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