臺灣身心障礙需求評估與服務輸送圖像：脈絡中的制度化效果

The Needs Assessment and Service Delivery for the Disabled in Taiwan: Effects of Institutionalization in Contexts

本文旨在說明各種理念、歷史脈絡，以及實踐的結構和個別因素如何影響臺灣身心障礙需求評估制度，以及福利服務輸送實踐，致使制度實踐的手段成為目的本身，讓其制度化效果與政策設計原意相悖。作者首先闡述新古典自由主義下，國家面對市場機制與社會保護二者拉扯的管理主義轉型，以及相對應於轉型下制度安排與變遷的臺灣身心障礙政策設計之發展歷程；接著，討論發展歷程中，身心障礙鑑定與需求評估的制度、變遷，以及制度化效果：除了本身蘊含獨立／依賴二分對立概念而來的成人中心和健常主義偏見的法定福利與服務項目外，評估之前預設的福利與服務分流制度，以及以法定福利與服務項目表列作為需求評估的內容，囿限對身心障礙者及其服務需要的想像，也限制實際服務輸送內容。導致在分流制度下，以「個人鑑定結果（的障礙類別與程度）」和「過去使用的法定服務之軌跡」去「應和」需求評估表所條列、從身心障礙權利的社會倡議而來、由身心障礙團體承攬提供的法定福利服務項目。最後，作者也討論相關的政策意涵作為結語。

 

In this study, the author examined how ideas, historical contexts, implemented structure and individual factors influenced needs assessment system for the disabled and the subsequent realization of the delivery system of welfare service in Taiwan. First, Taiwan’s transition to managerialism in the face of the tension between marketization and social protection under neoliberalism is expounded. Next, the specific development process and context that Taiwan underwent when designing policies for the disabled is explained. According to the discerned historical context, this study then discusses Taiwan’s disability evaluation and needs assessment systems and changes. The following effects of institutionalization is discerned: in addition to the legal welfare and service items that contain adult-centric and ableist biases originating from the independent-dependent dichotomous concepts, the streaming system for administrative conveniency, and the legal welfare and service items adopted as the content of needs assessment, have all restricted imaginations on the subject of the disabled and their needs as well as the content of actual service delivery. Implications on related policies are provided as the conclusion of this study.