公設民營模式下老人照護機構品質監督之研究

Study on Quality Maintenance of Elderly Institutional Care Service under “Operation Transfer” Mode

針對失能或失智老人提供之機構式照護服務，隨著老年人口迅速增加，將成為居家服務及社區服務外重要的照護服務形式。目前各縣市政府對於機構照護服務的提供多以「公設民營」方式委由民間辦理，而公權力機關以該方式遂行社會福利任務，其在法律上應採取之形式主要建立在促進民間參與公共建設法及政府採購法建構之模式，且同時亦須受憲法上民主原則及民生福利原則之限制。
然而照護服務之公設民營模式，如同其他福利服務之民營化，實際上面臨的並非完全競爭市場，從而委託機關與民間機構間的委託經營契約可能出現責信欠缺的結構性問題。對此，論者多認得引進外部監督及民眾參與之方式予以補強。同時，照護服務品質之維護尚賴健全之評鑑制度加以確保，本文認為參酌德國照護品質維護法之規定，應考量由委託機關以外之機構執行。在指標項目之建立上則應擴大利害關係人及受評機關之參與，且考量品質維繫之連續性及即時性，至少每一年應辦理一次評鑑。另受評機構的程序權利及請求不予公開評鑑結果之主觀公權利亦應予以保障。

With the tremendous growth of elderly population, institutional care-service aiming at physically or mentally disabled elderly persons has increased its importance. The mode “Operation Transfer” is broadly taken as a method to perform the task of social welfare by the government. Legal structure of this mode can be found both in “Act for Promotion of Private Participation in Infrastructure Projects” and “Government Procurement Act”. Under frame of Constitution, “Principle of Democracy” and “Principle of social welfare” bind and restrict the privitization of social welfare. However, as other objects of privitzation in the field of social-welfare, the incomplete competitive market of care-service causes problems connecting to lack of accountability. As a solution, scholars recommend to strengthen external oversight and public participation.
Meanwhile, a complete evaluation system is necessary for the maintenance of caring quality. In this essay, the author takes german’s “Act for maintenance of caring quality” as a comparison and asserts the following reforms to be necessary: (1)Evaluation should be enforced by a neutral institution other than the outsourcing government. (2)Related persons and evaluated institutions have rights to participate in the establishments of evaluation items and standards. (3)To reflect the latest circumstances of caring, evaluation should be taken at least once per year. (4)Rights of evaluated institutions should also be taken into consideration, especially processive rights and the right to stop government from publishing the result of evaluation.