| 摘要: | 行政院2005年推動「臺灣健康社區六星計畫」，以社區營造及社區自主參與為基本精神，鼓勵民間單位建立「社區照顧關懷據點」。據點的特色在於(一)鼓勵社區自主提案或在既有老人服務單位成立據點；(二)承辦單位具轉換據點類型的轉換性；(三)辦理服務項目之選擇權。因此，相較於過去購買服務契約執行方式，據點計畫有別於「以價制量」或「以價格標」等委託方式，鼓勵各類型單位承辦據點服務，且允許承辦單位依據本身服務能量與特色自行選擇服務項目。據此，研究者將此特色定義為非營利組織之「選擇性策略」，並以「資源相互依賴模型」（Resource Interdependence Model）理論分析非營利組織與政府的購買式契約委託互動關係。
本研究運用「次級資料分析」（Secondary Qualitative Study），分析非營利組織承接長期照顧方案的資源結構、台北市歷年關懷據點數量變化與其承辦之非營利組織的類型與辦理狀態分析，並從「進場誘因」與「進場門檻」兩面向檢視政府購買服務方案的資源結構。依據研究結果，關懷據點計畫期待以三年期間的經費補助啟動社區自立與在地資源投入而降低對補助的依賴，但經費型據點仍長期申請經費補助；而功能型據點之承辦單位所辦理的老人服務方案相當多元且其皆同為公設民營老服中心承辦單位。
研究者依據次級資料結果，進一步採用「個案研究法」深入分析非營利組織承接功能型或經費型據點之策略。研究發現，據點承辦單位選擇參與購買服務的因素，為追隨政府政策引導獲得方案資源，即是社會福利界的「遊牧民族」；再者，便可達到「名、利雙收」的效益，一方面獲得政府與社區服務使用者的認可(聲譽)，另一方面獲得更多的方案辦理與募款機會(利益)；另外，功能型與經費型據點原為各自獨立運作，但兩類據點因委辦單位(臺北市政府)之公設民營契約規範促使其發生輔導關係，辦理功能型據點的老福中心，可藉由輔導區域內經費型據點取得建構社區服務網絡的「機會」(opportunity)，提供經費型據點所需的服務知能與教育訓練，扮演該區域服務加盟總店之角色，而經費型據點則回饋老服中心個案服務的協助，成為區域加盟者。
本研究對於社區照顧關懷據點的未來發展提出政策建議。首先，有鑒於現行方案較屬零散式的補助模式，為了服務使用者獲得完整的服務，非營利組織只能透過不斷申請各種方案經費，成為經費堆疊的遊牧民族，回顧台灣近十年長期照顧發展相當快速且多元，但應開始進一步省思現今長照政策的缺口，著重服務使用者為導向之服務設計，針對周延性不佳之政策加以重新整併之必要性；其次，關懷據點政策本身已具備兩類型據點模式，且鼓勵各類型服務單位投入辦理，但並未針對其功能、社區角色與互動關係進行討論，本研究認為應提升兩類型據點互動的可行性，結合雙方優勢發揮加乘作用；另一方面，現行的據點考核制度並未兼顧多元的承辦單位，建議應調整現行的考核機制符合不同服務基礎單位，強調社區自立與在地資源投入為考核目標。
In 2005, Executive Yuan promote "Community Care Stations", which participate with community building and community autonomy as the basic spirit to encourage non-profit organizations to establish "Community Care Stations".
The Features of Community Care Stations lies in:
(A) To encourage the community proposal voluntarily or to establish the service spot in the existing elder non-profit organizations; (B) To make the non-profit organizations characterize with the conversion to convert the spot; (C) To have the right of choosing services.
Therefore, the researchers of this characteristic is defined as a non-profit organization "selective strategy", which is based on the analytical framework of Resource Interdependency Model with non-profit organizations and government commissioned the purchase contract type interaction.
In this study, Secondary Qualitative Study, analysis includes non-profit organizations to contracting long-term care program resource structure, community stations number of changes over the years and types of nonprofit organizations and contractors handling state in Taipei city. As the result of research community station programs expect for three years Funded start of community self-reliance and the investment of resources in the ground, but the funding stations still apply chronically for the financial subsidy or funding grants; Functional community stations offer services for the elderly are more program, and contracting-out for the old service center.
Researchers based on secondary data results, further using "case study" analysis of the strategies of Non-profit organizations in the contracting of community care stations. The study found that non-profit organizations choose to participate in the purchase of services because to following the government policy guidance to get the program resources, that is, the social welfare sector, "nomads"; In addition, they can reach the benefits of reputation and interests, on the one hand, to get government and community service users recognized (reputation), on the other hand, to get more programs to apply and fundraising opportunities (interests);Furthermore, functional and funding community care stations originally operate independently, but commissioned units (Taipei City Government) of the contracting-out specifications to promote its occurrence private counseling relationship, to provide funding community care stations Service knowledge and training to play the role of the regional headquarters of joining the service, the funding will contribute to help the old type stronghold casework service center, be a regional franchisees.
The study provides recommendation for the future development of Center of policy. First, in view of the current program are scattered subsidy model; in order to service users get complete service, Nonprofit organizations just apply for various programs, becoming nomads, needing to reflect on long-term care policy, focusing on service users to refresh the policy
Secondly, there have been two types of mode in community care stations already and encourage investment in handling all types service units, this study considers two types of locations should enhance interaction and combine their strengths to play a synergistic role; the current evaluation system does not take into account the diverse locations of the contractor proposal evaluation mechanism should be adjusted in line with the existing basis of different service units. |
