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

在高齡化社會中，如何滿足與日俱增的照顧服務量為各國長期照顧政策探討的重點。然而，服務提供組織屬性與照顧品質的爭辯始終是公共政策領域關注的焦點，但以付費能力相對弱勢者為對象，探討混合經濟市場中服務組織選擇服務對象的研究尚待累積。本研究採取次級資料分析及深度訪談法，資料來自臺北市政府提供2006 至2010 年間公費老人入住機構名冊與入住人數，訪談對象包括地方政府主管與照顧機構主管。臺北市公費老人機構補助金額僅趨近私立小型乙等機構收費標準，對評鑑等第甲等以上機構缺乏誘因；惟私立小型甲等以上機構受限於老人福利機構設立標準之規範，僅能運用公費老人補助攤平空床成本，但財團法人機構卻因政府補助而弱化服務公費老人動機。為避免照顧品質較好的機構成為公費老人可望而不可及的服務，建議臺北市機構式照顧服務的政策大幅修正，透過評鑑與獎勵機制提升不同屬性照顧機構接受公費老人入住的誘因，亦可作為其他縣市公費老人安置委託服務之參考。

After passing the first amendment of Taiwan’s Senior Citizen Welfare Act in 1997, the government has allowed long-term care institutions to operate as for-profit entities. One of the government’s strategies has been to encourage both non-profit and for-profit institutions to become service providers. Whether such changes have benefitted the industry is questionable. It is important to understand the causal relationships between institutional attributions and the social role in serving the low-income elderly. This paper focused on explaining how and why providers of long-term institutional care for Taipei’s low-income elderly are mainly for-profit institutions, particularly small institutions. Secondary data analysis, documentary analysis and in-depth interviews were used to examine the quantity and proportion of the purchase of low-income elderly services from non-profit and for-profit institutions by the Taipei City Government from 2006 to 2010. In addition, institutions’ positions and strategies, as well as Taipei’s related long-term care policies and programs were carefully examined. This research found that government subsidies for Taipei’s low-income elderly are nearly enough to cover for-profit C class fees; A and B class institutions thus limit low-income admissions. The reason for the for-profit A and B class institutions admitting low-income elderly is to make up for unoccupied bed costs. However, non-profit institutions get additional subsidization for staff and facilities, so providing service to the low-income elderly results in less pressure, causing a right-and-responsibility imbalance and unfair competition between non-profit and for-profit institutions. Modifying Taipei’s subsidy policies for low-income elderly care institutions is necessary, and will set an example for other city governments.