| 摘要: | 精神病患醫療照護的另ㄧ條路徑；社區精神復健治療，自1989年衛生署所公告推動的「精神病患社區復健試辦計畫」，主要以「發展積極的治療與復健，減少收容與養護」為政策導向，因此政府以契約方式委託民間團體參與社區精神復健服務輸送，並且希望能使服務品質產生最大效益，因此，制定精神復健機構設置管理與績效評鑑機制，確保受服務者有個別化的需求與照顧服務。 公私協力是政府治理公共事務的策略工具，政府依賴民間多元資源、創新訓練活動，彈性有效率的行政作業，以節省公部門成本、增加效能。本研究方法採質性研究之個案分析，收集公私協力的相關文獻資料後，參考吳英明之垂直分隔、水平互補、以及水平融合等三種互動模式，探討高雄市日間型社區精神復健機構與公部門的協力互動關係，從「協力脈絡」、「協力執行」、「協力評估」三項構面發展研究架構，瞭解公部門對私部門的助力及執行服務過程中私部門遭受的困境與解決問題的策略，以半結構式訪談高雄市經營管理社區復健中心的負責人，透過受訪者個人感受、經驗的陳述，與文獻資料的理論相比較，應驗研究的目的。 本研究發現，公私協力互動模式由垂直分隔互動模式發展到水平互補互動模式，私部門希望與公部門建立有效溝通協調平台，達到彼此間平等、互惠、相互依存的協力關係，而協力的困境來自政策面、治理面、執行面，導致1.缺乏明確且清楚的協力目標。2.中央與地方的權責不明。3.行政作業繁瑣。4. 不信任、怕圖利他人心態。5.權力不對等。6.給付不對價等問題。建議公部門簡化審查收案行政流程，廣納社區復健業者、受服務者及精障者之主要照顧者意見，修訂在職教育課程加入相關勞政資源、職業重建、產品行銷，復元(Recovery)概念，並跨部門合作，協助精神障礙者就業及產品銷售管道，達成公私協力雙贏的成效。
There is another way for medical care for mentally-disordered patients - community mental rehabilitation therapy. Since 1989, the Department of Health, Executive Yuan, has announced and promoted the “Community Mentally-Disordered Patient Rehabilitation Trial Program” which has a policy oriented toward “development of active remedy and rehabilitation, decrease of shelter and care.” Thus, the government has entrusted private groups by signing contract with them for their involvement in community mental rehabilitation service conveyance in the hope of maximizing benefits of service quality. Therefore, the government has set up mental rehabilitation organization management and performance evaluation mechanism to ensure that patients who receive service enjoy individualized demand satisfaction and care service. Public-private partnership is a strategic tool for the government to manage public affairs. The government relies on non-governmental organizations’ multiple resources, innovative training activities, flexible and efficient administrative operations so as to save cost and increase efficiency for public sectors. The present study adopted qualitative research for a case study to collect and analyze related references and literatures about public-private partnership. After that, Wu, Ying-ming’s three interactive modes–vertical segregation, horizontal complementation and horizontal fusion were used to discuss the joint and interactive relationship between day community mental rehabilitation organizations in Kaohsiung city and public sectors. From the three aspects of “joint history,” “joint execution,” “joint evaluation,” the research framework was developed to understand public sectors’ help to private sectors and obstacles private sectors are confronted with as well as problem-solving strategy during the course of service execution. By semi-structured interview with the responsible person who runs and manages one community rehabilitation center in Kaohsuing city, the research purpose has been testified through the comparison between the interviewee’s statements about his/her personal feelings and experiences and theories from literature. It was found that the interactive mode of public-private partnership has been evolved from vertical segregation to horizontal complementation. Private sectors hope to establish a platform for effective communication and negotiation with public sectors so that an equivalent, reciprocal, interdependent partnership can be built. The obstacles to partnership have been from factors related to policy, governance, execution , that resulted in the following situations. （1） There is no specific and clear partnership goal. （2） There is no clear-cut power and responsibility distinction between central government and local government. （3） Administrative affairs are minute and complicated. （4） A mindset that does not trust and fears taking advantage of others exists. （5） There is no equivalent power. （6） Service provided by private sectors is underpaid by public sectors. It is suggested that public sectors should simplify the administrative procedures of review and case closing, hear the voice of primary caretakers of community rehabilitation, the served people and mentally-disordered patients, modify educational curriculum for staff in-service by including related labor administration resources, occupation rehabilitation, product marketing and the concept of recovery. Also, public sectors should work on cross-sectoral cooperation, assist mentally-disordered patients with obtaining employment and product marketing channel and eventually create a win-win situation for both public and private sectors. |
