社區照顧服務輸送模式之探討

Exploring Service Delivery Models of Community Care

10.6785/SPSW.200012.0179

黃源協(Yuan-Shie Hwang)

社區照顧 ； 科層－專業主義 ； 新管理主義 ； 新專業－新管理 ； community care ； bureau-professionalism ； new managerialism ； new professional-new management

社會政策與社會工作學刊

4卷2期（2000 / 12 / 01）

179 - 220

繁體中文

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。

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.

1. (1993).Quasi-market and Social Policy.London:Macmillan.
2. Abbott, P., Meerabeau, L.(1998).The Sociology of the Caring Professions.London:UCL Press.
3. Brechin, A.(2000).Critical Practice in Health and Social Care.London:SAGE.
4. Butcher, T.(2000).Changing Practice in Health and Social Care.London:SAGE.
5. Causer, G., Exworthy, M.(1999).Professionals and the New Managerialism in the Public Sector.Buckingham:Open University Press.
6. Clarke, J.(1998).The Sociology of the Caring Professions.London:UCL Press.
7. Clarke, J.(1993).A Crisis in Care - Challenges to Social Work.London:SAGE.
8. Clarke, J., Newman, J.(1997).The Managerial State.London:SAGE.
9. Davies, C.(1998).Understanding Health and Social Care - An Introductory Reader.London:SAGE.
10. Davies, C.(2000).Critical Practice in Health and Social Care.London:SAGE.
11. Davies, C.(2000).Changing Practice in Health and Social Care.London:SAGE.
12. Department of the Environment, Transport and Regions (DETR)(1998).Moderning Local Government - Improving Local Services through Best Value.London:TSO.
13. Exworthy, M., Halford, S.(1999).Professionals and the New Managerialism in the Public Sector.Buckingham:Open University Press.
14. Finlay, L.(2000).Critical Practice in Health and Social Care.London:SAGE.
15. Flynn, R.(1999).Professionals and the New Managerialism in the Public Sector.Buckingham:Open University Press.
16. Glennerster, H.(1992).Paying for Welfare: The 1990's.Hemel Hempstead:Harvester Wheatsheaf.
17. Hadley, R., Clough, R.(1996).Care in Chaos-Frustration and Challenge in Community Care.London:Cassell.
18. Henwood, M.(1995).Strained Relations.Health Service Journal,6
19. Hodkinson, P., Issitt, M.(1995).The Challenge of Competence: Professionalism through Vocational Education and Training.London:Cassell.
20. Hoggett, P.(1991).A new management for the public sector?.Policy and Politics,19
21. Hughes, O. E.(1998).Public Management and Administration.New York:ST. Martin's Press.
22. Hugman, R.(1998).The Sociology of the Caring Professions.London:UCL Press.
23. Johnson, M.(1999).New Labour, New Welfare State - The 'third way' in British social Policy.Bristol:The Policy Press.
24. Jones, L., Tucker, S.(2000).Critical Practice in Health and Social Care.London:SAGE.
25. Kelly, A.(1998).The Social Construction of Community Care.London:Macmillan.
26. Kelly, A.(1998).The Social Construction of Community Care.London:Macmillan.
27. Langan, M.(1998).Development in British Social Policy.London:Macmillan.
28. Le Grand, J.(1994).Evaluating NHS Reform.Hermitage:Policy Journal.
29. McDonald, A.(1999).Understanding Community Care - a guide for social workers.London:Macmillan.
30. Means, R., Smith, R.(1998).From Poor Law to Community Care - The development of welfare services for elderly people 1939-1971.Bristol:The Policy Press.
31. Newman, J.(1998).Unsettling Welfare - the Reconstruction of Social Policy.London:the Open University.
32. Newsman, J., Clarke, J.(1994).Managing Social Policy.London:Sage.
33. Overtveit, J.(1993).Coordinating Community Care - Multidisciplinary Teams and Care Management.Buckingham:Open University Press.
34. Payne, M.(1986).Social Care in the Community.London:Macmillan.
35. Pollitt, C.(1993).Managerialism and the Public Services: The Anglo-American Experience.Oxford:Basil Blackwell.
36. Rashid, S.(2000).Changing Practice in Health and Social Care.London:SAGE.
37. Saks, M.(2000).Changing Practice in Health and Social Care.London:SAGE.
38. Sheppard, M.(1995).Care Management and Social Work.London:Whiting ＆ Birch.
39. Southon, G., Braithwaite, J.(2000).Changing Practice in Health and Social Care.London:SAGE.
40. Steward, J.(1993).The limitations of management by contract.Public Money and Management,13
41. Symonds, A.(1998).The Social Construction of Community Care.London:Macmillan.
42. Walker, A.(1997).Community Care: A Reader.London:Macmillan.
43. Walsh, K., Deakin, N., Smith, P., Spurgeon, P., Thomas, N.(1997).Contracting for Change - Contracts in Health, Social Care, and Local Government Services.New York:Oxford University Press.
44. Wright, K., Haycox, A., Leedham, I.(1994).Evaluating Community Care - services for people with learning difficulties.Buckingham:Open University Press.
45. Zifcak, Spencer(1994).New Managerialism: Administrative Reform in Whitehall and Canberra.Buckingham:Open University Press.
46. 黃源協 Hwang, Yuan-Shie(2000)。社區照顧－台灣與英國經驗的檢視。台北:揚智文化。

1. 陳柏宗、陳世明(2006)。社區組織參與老人社區照顧之研究：以台南市長榮社區爲例。社會政策與社會工作學刊，10(1)，49-113。
2. 侯建州(2018)。新管理主義對於醫院醫療服務之影響：給醫務社會工作的啟示。臺灣社會工作學刊，21，37-78。
3. 黃源協、侯建州(2012)。專業主義v.s.管理主義：英國社會工作歷史的檢視。臺灣社會工作學刊，10，1-46。
4. 陸悌、林東龍、王美懿(2014)。精神醫療團隊於莫拉克颱風災後心理重建之在地實踐經驗：兼論精神社工專業角色的省思。臺大社會工作學刊，29，97-148。
5. 蘇俊丞(2017)。初探社會福利服務「方案委外」型態～以公部門兒童保護業務為例。中國地方自治，70(4)，33-48。
6. 魏季李(2015)。非營利福利機構與政府的服務契約委託過程的決策與影響研究：以臺灣兒童暨家庭扶助基金會為例。社會政策與社會工作學刊，19(2)，109-144。
7. (2002)。身心障礙福利機構運用ISO 9000品質保證制度可行性探討。社區發展季刊，97，197-217。
8. (2005)。從資源網絡連結看社區照顧網之建構—以臺南縣村里關懷中心實施運作為例。社區發展季刊，110，476-491。
9. (2007)。專業主義、新管理主義與最佳價值—社會工作專業教育的挑戰與回應。社區發展季刊，120，85-105。
10. (2013)。由社會福利政策綱領談日本社區整合性照護體系。社區發展季刊，141，442-463。
11. (2014)。社區老人社會網絡與社會支持之研究－以參與臺南市啟智社區與沙灘社區推動的社區照顧服務活動的老人為例。社區發展季刊，147，317-334。
12. (2017)。彰化縣馬興社區關懷據點的服務成效探討。社區發展季刊，157，348-360。
13. (2018)。初探公私協力下的兒童保護業務推動。社區發展季刊，163，176-186。