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Title: | 同心協力或貌合神離∶中國大陸地方社區養老服務政社關係之探析 Same Bed,Different Dream?The study of Collaborative Governance Mechanism on Community Care for Elderly in Mainland China |
Authors: | Liang Zhou 周靓 |
Advisor: | 郭銘峰(Ming-Feng Kuo) |
Keyword: | 醫養結合,協力治理,政社關係,社區養老,博弈合作, Integration of medical care and nursing,Collaborative governance,relationship between government and community,Community support for the elderly,Game collaboration., |
Publication Year : | 2019 |
Degree: | 碩士 |
Abstract: | 中國大陸面臨越來越嚴重的人口老齡化問題,如何實現「老有所養」已成為政府刻不容緩的重要議題。對此,政府不斷推出相關政策舉措,並在「十三五」規劃中尤為強調,要「建設以居家為基礎、社區為依託、機構為補充、醫養相結合的多層次養老服務體系」,而在實踐過程中形成了包括如「養中設醫」、「醫中設養」與「醫養合作」等不同的「醫養結合」模式。在這些不同的養老服務供給中涉及到政府、醫療企業、社會組織、社區自治組織與社區老人等不同參與主體,但這些參與主體在不同的「醫養結合」養老模式中,如何有效合作實現有效地協作治理值得深入關注。鑒此,本文以杭州市上城區發展醫養結合實踐為例,透過政策背景的理解,並輔以田野調查與訪談,著力於研究這一案例中的運行機制及共性,最後建構醫養結合模式中政社之關係,讓醫養結合中多元主體能夠真正融合,以豐富大陸協力治理之資訊。
研究發現,杭州市上城區醫養結合模式中政府與社會之間未能形成良好的協力關係,主要原因是:雙方資源權力失衡、社會參與動機不足、溝通機制不足及雙方並未達成協力共識。對此,本研究提出未來促進政府與社會在醫養結合模式中融合之策略建議,包括:建立統一管理委員會應對多部門協作出現的溝通不當與資源共享度低之困境、建立階梯式的補助機制對不同性質的養老機構進行補貼及取消公立醫療機構財政補貼轉為服務醫護人員直接補貼以增強參與動機、建立即時溝通平台及多元利害關係人聯席會議制度加強政社互動與溝通等事項。 The Mainland China is facing an increasingly serious problem - population aging. How to provide care for the elderly has become an urgent and important issue for the government. Therefore, the government has continuously launched relevant policies and measures, and in “The 13th Five-year Plan”, it particularly emphasized to “build a multi-level elderly care service system based with home, relying on community, supplemented by institutions, integrated with medicine and nursing”; In the process of practice, different modes of integration of medical care and nursing, such as “medical care in nursing”, “nursing in medical care” and “collaboration of medical care and nursing”. In these different elderly care service supplies, there are different participants such as government, medical enterprises, social organizations, community autonomous organizations and community elderly, but how do these participants carry out effective cooperation in different models of integrating medical care with old-age care to achieve effective collaborative governance is worth in-depth attention. In view of this, this paper takes the practice of integrating medical care with nursing in Shangcheng District of Hangzhou City as an example. Through the understanding of the policy background, supplemented by field investigation and interview, this paper focuses on studying the operation mechanism and commonness in this case. Finally, the relationship between the government and the community was constructed in the model of integration of medical care and nursing so as to truly integrate the multiple subjects in the model and enrich the information of collaborative governance in mainland China. The results show that the main reasons for the failure to form a good collaborative relationship between the government and the society in the model of integration of medical care and nursing in Shangcheng District of Hangzhou City include: The imbalance of resources and power between the two sides, the lack of motivation for social participation, the insufficient communication mechanism and the failure of the two sides to reach a consensus. To handle with these issues, this study proposes the following strategies to promote the integration of government and society in the model of integration of medical care and nursing in the future - to set up a unified management committee to improper communication multisectoral coordination occur with the dilemma of low degree of resource sharing. To set up the stepwise mechanism of subsidy to subsidise the endowment institutions of different nature, and cancel the public medical institutions, change to direct subsidies to service staff to increase participation motivation. To set up the system of joint conference for instant communication platform, and multiple stakeholders to strengthen the government and social interaction and communication, etc. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/73533 |
DOI: | 10.6342/NTU201900600 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 公共事務研究所 |
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ntu-108-1.pdf Restricted Access | 2.5 MB | Adobe PDF |
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