健全老人長期照顧機構治理工具之多層次網絡治理分析

A Multi-Level Network Governance Analysis on Governance Tools for Elderly Long-Term Care Institutions

10.6785/SPSW.202106_25(1).0002

蕭文高(Wen-Kao Hsiao)

老人照顧機構 ； 多層次治理 ； 網絡治理 ； 治理工具 ； elderly care institutions ； multi-level governance ； network governance ； governance tools

社會政策與社會工作學刊

25卷1期（2021 / 06 / 01）

49 - 91

繁體中文

為因應人口快速老化所產生之照顧服務需求，政府於近年陸續推展長期照顧十年計畫；老人機構式照顧是整體長期照顧服務體系之一環，扮演照顧最後一道防線之功能，然而層出不窮之機構事故顯現治理工具失靈，值得深入分析。為此，本文主要目的在於透過文獻與政策文件之探討，以多層次網絡治理為分析概念，剖析老人長期照顧機構治理工具之現況與限制。研究發現相關治理體系在照顧費用補助、機構經營成本補助與地方政府行政人力補助存在缺失，且機構評鑑制度與查核成效有待提升，訊息性治理工具亟需修正等問題。基於前述發現，本文最後建議政府應進行長期照顧機構營運收支分析、整合規劃相關支付制度、建立長照服務專責管理體系，並善用訊息性工具，以回應經營者及服務使用者之需求。

In response to the rapid aging of the population and increasing need for care services, the government has launched various parts of the Long-term Care Plans over the past few years. Institutional care for the elderly is part of the overall long-term services system and the last line of defense in elderly care; however, continued accidents in the facilities showed the failure of certain governance tools. For this reason, the main purpose of this article is to analyze the current status and limitations of governance tools for elderly long-term care institutions through a literature and policy document review with the multi-level network governance perspective. Following a systematic review, this study found defects in the arrangement of care payment, supplier subsidies, and administration funding. Furthermore, in regard to the effectiveness of the inspection and auditing systems, information-related instruments need to be improved. Finally, based on the research finding and to meet supplier and citizens' needs, this paper suggests that the government should analyze the revenue and expenditure of long-term care institutions, dedicate its efforts on the integrated planning of the payment system, frame a centered regulating system, and improve information instruments.

1. 馬立德,葉俊廷,劉以慧(2017)。我國小型長期照顧機構經營困境及策略之研究。社會發展研究學刊，20，61-81。
   連結：
2. 陳正芬,官有垣(2015)。可望而不可及的服務：臺北市長期照顧機構組織屬性與公費安置老人服務量之研究。臺大社會工作學刊，32，33-78。
   連結：
3. 陳正芬,官有垣(2011)。台灣機構式長期照顧服務組織屬性與政府相關政策演變之探討。社會政策與社會工作學刊，15(1)，91-135。
   連結：
4. Acciai, C.,Capano, G.(2018).Climbing Down the Ladder: A Meta-analysis of Policy Instruments Applications.IPPA International Workshops on Public Policy
5. Agranoff, R.(2018).Local Governments in Multilevel Governance: The Administrative Dimension.London:Lexington Books.
6. Alfers, L.(2019).Shaping Society from Below: Social Movements, Social Policy and Development.Handbook of Social Policy and Development,Cheltenham:
7. Amirkhanyan, A. A.,Meier, K. J.,O’Toole, L. J., Jr(2017).Managing in the Regulatory Thicket: Regulation Legitimacy and Expertise.Public Administration Review,77(3),381-394.
8. Andersson, K.,Hanberger, A.,Nygren, L.(2018).Governance, Accountability, and Organizational Development: Eldercare Unit Managers’ and Local Politicians’ Experiences of and Responses to State Supervision of Swedish Eldercare.Journal of Aging & Social Policy,30(5),419-439.
9. Anttonen, A.(ed.)(2003).The Young, the Old and the State: Social Care Systems in Five Industrial Nations.Cheltenham:Edward Elgar.
10. Arlotti, M.,Aguilar-Hendrickson, M.(2018).The Vicious Layering of Multilevel Governance in Southern Europe: The Case of Elderly Care in Italy and Spain.Social Policy & Administration,52(3),646-661.
11. Bemelmans-Videc, M. -L.,Rist, R. C.,Vedung, E.(2011).Carrots, Sticks, and Sermons: Policy Instruments and Their Evaluation.New York:Routledge.
12. Bevir, M.(2012).Governance: A Very Short Introduction.Oxford:Oxford University Press.
13. Boll, T.(ed.)(2018).Cultures of Care in Aging.Charlotte, NC:Information Age Publishing.
14. Caponio, T.(2019).Researching Multilevel Governance: A Local Government Perspective.Journal of Public Administration Research and Theory,29(2),372-374.
15. Charbit, C.(2011).OECD Regional Development Working PapersOECD Regional Development Working Papers,Paris:.
16. Chou, M. -H.,Jungblut, J.,Ravinet, P.,Vukasovic, M.(2017).Higher Education Governance and Policy: An Introduction to Multi-issue, Multi-level and Multi-actor Dynamics.Policy and Society,36(1),1-15.
17. Cunningham, S.,Taylor, B. J.,Murphy, A.(2020).Standards in Regulating Quality of Adult Community Health and Social Care: Systematic Narrative Review.Journal of Evidence-Based Social Work,17(4),457-468.
18. Enderlein, H.(ed.)(2010).Handbook on Multi-level Governance.Cheltenham:Edward Elgar.
19. Gori, C.(ed.)(2015).Long-term Care Reforms in OECD Countries: Successes and Failures.Bristol:Policy Press.
20. Hanberger, A.,Lindgren, L.(2019).Evaluation Systems in Local Eldercare Governance.Journal of Social Work,19(2),233-252.
21. Hooghe, L.,Marks, G.,Schakel, A. H.,Osterkatz, S. C.,Niedzwiecki, S.,Shair-Rosenfield, S.(2016).Measuring Regional Authority: A Postfunctionalist Theory of Governance.New York:Oxford University Press.
22. Kapucu, N.,Hu, Q.(2020).Network Governance: Concepts, Theories, and Applications.New York:Routledge.
23. Larsson, O.(2015).The Governmentality of Meta-governance. Identifying Theoretical and Empirical Challenges of Network Governance in the Political Field of Security and Beyond.Uppsala:Acta Universitatis Upsaliensis.
24. Larsson, O.(2019).A Theoretical Framework for Analyzing Institutionalized Domination in Network Governance Arrangements.Critical Policy Studies,13(1),81-100.
25. Marks, G.,Hooghe, L.,Blank, K.(1996).European Integration from the 1980s: State-centric v. Multi-level Governance.Journal of Common Market Studies,34(3),341-378.
26. McGuire, M.,Agranoff, R.(2011).The Limitations of Public Management Networks.Public Administration,89(2),265-284.
27. Miller, E. A.,Mor, V.(2006).Out of the Shadows: Envisioning a Brighter Future for Long-term Care in America.Rhode Island:Brown University.
28. Mor, V.(2014).A Framework for Understanding Regulation of Longterm Care Quality.Regulating Long-term Care Quality: An International Comparison,Cambridge:
29. Mukamel, D. B.,Weimer, D. L.,Harrington, C.,Spector, W. D.,Ladd, H.,Li, Y.(2012).The Effect of State Regulatory Stringency on Nursing Home Quality.Health Services Research,47(5),1791-1813.
30. Olsen, G. M.(2019).Protective Legislation: The "Third Pillar" of the Welfare State.Social Policy & Administration,53(3),478-492.
31. Organization for Economic Co-operation and Dovelopment=OECD(2019).Making Decentralisation Work: A Handbook for Policymakers.Paris:OECD Publishing.
32. Osborne, S. P.(ed.)(2010).The New Public Governance? Emerging Perspectives on the Theory and Practice of Public Governance.London:Routledge.
33. Peters, B. G.,Pierre, J.(2001).Development in Intergovernmental Relations: Towards Multi-level Governance.Policy & Politics,29(2),131-135.
34. Piattoni, S.(2010).The Theory of Multi-level Governance: Conceptual, Empirical and Normative Challenges.Oxford:Oxford University Press.
35. Piattoni, S.(2009).Multi-level Governance: A Historical and Conceptual Analysis.Journal of European Integration,31(2),163-180.
36. Pierre, J.,Peters, B. G.(2020).Governance, Politics and the State.London:Red Globe Press.
37. Stephenson, P.(2013).Twenty Years of Multi-level Governance: Where does it Come from? What is it? Where is it Going?.Journal of European Public Policy,20(6),817-837.
38. Stilwell, F.,Troy, P.(2000).Multilevel Governance and Urban Development in Austria.Urban Studies,37(5-6),909-930.
39. Stoker, G.(2004).Transforming Local Governance: From Thatcherism to New Labour.Basingstoke:Palgrave Macmillan.
40. Sullivan, H.,Knops, A.,Barnes, M.,Newman, J.(2004).Centrallocal Relations in an Era of Multi-level Governance: The Case of Public Participation Policy in England, 1997-2001.Local Government Studies,30(2),245-265.
41. Tan, E.(2019).Decentralization and Governance Capacity: The Case of Turkey.Cham:Palgrave Macmillan.
42. Taylor-Gooby, P.(ed.)(2004).New Risks, New Welfare: The Transformation of the European Welfare State.Oxford:Oxford University Press.
43. Tortola, P. D.(2017).Clarifying Multilevel Governance.European Journal of Political Research,56(2),234-250.
44. Walshe, K.(2001).Regulating U.S. Nursing Homes: Are we Learning from Experience?.Health Affairs,20(6),128-144.
45. Williams, F.(2016).Critical Thinking in Social Policy: The Challenges of Past, Present and Future.Social Policy & Administration,50(6),628-647.
46. 內政部(2008).老人安養、長期照顧機構社工人員操作手冊.臺北:
47. 王榮璋,黃琢嵩,高珮瑾(2014)。我國社會福利補助經費設算制度及社會福利施政績效考核修正芻議。社區發展季刊，145，266-287。
48. 林淑勤,嚴于屏(2017)。一般性社會福利補助經費設算制度執行情形之檢討。主計月刊，744，40-46。
49. 范家榮(2012)。國立東華大學課程設計與潛能開發學系。
50. 國家發展委員會(2020).中華民國人口推估（2020至2070年）.臺北:
51. 陳小紅（2020）。《監察院調查報告（109 內調 0065 號）》。監察院網頁（https://cybsbox.cy.gov.tw/CYBSBoxSSL/edoc/download/31292）。
52. 陳美蕙(2012)。南華大學非營利事業管理學系。
53. 黃元瑤(2015)。國立中正大學社會福利學系暨研究所。
54. 黃彥滔(2020)。國立暨南國際大學非營利組織經營管理碩士學位學程在職專班。
55. 楊培珊,王潔媛,汪明璇(2005)。推動「小型老人養護機構社工服務方案」經驗分析。社區發展季刊，110，321-339。
56. 監察院（2016）。《糾正案文，105 內正 0019》。監察院網頁（https://www.cy.gov.tw/CyBsBoxContent.aspx?n=134&s=4849）。
57. 監察院（2017）。《糾正案文，案號 106 內正 0019》。監察院網頁（https://www.cy.gov.tw/CyBsBox.aspx?n=134&CSN=2&page=18&PageSize=20）。
58. 監察院（2017）。《糾正案文，106 內正 0012》。監察院網頁（https://www.cy.gov.tw/CyBsBoxContent.aspx?n=133&s=5677）。
59. 衛生福利部社會及家庭署（2021）。《110 年上半年全國老人福利機構名冊》。衛生福利部社會及家庭署網頁（https://www.sfaa.gov.tw/sfaa/pages/detail.aspx?nodeid=366&pid=2630）。
60. 衛生福利部統計處（2021）。《老人長期照顧、安養機構概況》。衛生福利部統計處網頁（https://dep.mohw.gov.tw/dos/cp-2977-13854-113.html）。
61. 蕭文高(2020)。在地老化理念的實踐—長期照顧服務體系的反思？。長期照顧：理念、政策與實務的檢視，臺北:
62. 賴添福(2012)。嘉義大學管理學院碩士在職專班。

1. 洪士峰,巫麗雪(2023)。在機構安老：鑲嵌在機構照顧下彈性的日常生活安排。社會政策與社會工作學刊，27(1)，1-46。