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

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.