長期照顧體系組織改造策略分析：全觀型治理觀點
江大樹、梁鎧麟
《摘要》
打造一個精實、彈性、高效能的政府組織，提升國家競爭力，乃當前行政院組織改造的願景目標。二○一○年一月十二日，立法院三讀通過行政院組改配套法案，將原本37個部會精簡為29個，正式開啟這一波政府組織改造工程。其中，整合衛政、社政兩個體系而新設的衛生福利部，也是一項眾所矚目的組織整併方案。隨著台灣高齡人口快速成長，對長期照顧體系的需求日益殷切，以往分屬衛生、社福兩個不同部門的政策規劃與執行，難免存在因專業分工所導致的本位主義，造成各項服務輸送屢見扞格不入現象。因此，衛生福利部未來是否及如何能有效整合長期照顧體系，徹底解決現行組織運作的碎裂化問題，特別值得關注。
本文藉由全觀型治理所強調的組織協調、服務整合等興革理念，嘗試分析當前長期照顧體系的問題與缺失，進而提出衛生福利 部成立後應有的興革策略。筆者提出兩個主要論述：（一）各種協調策略並行：在整合成為單一部會組織前，應先透過全觀型協調策略，進行組織間相互資訊流通；中央與地方政府的衛政及社政部門彼此互動，應採容忍性制度協調型態；至於，政府部門與外部行為者間應採取分立或權變協調型態。（二）建構五項全觀型整合策略：規劃一套長照資訊系統、研發長照體系跨域服務方案、中央與地方政府定期舉行長照會報、領導者應具備創造符號與衝突管理的技巧、提供組織學習機會。
[關鍵詞]：長期照顧體系、組織改造、衛生福利部、全觀型治理
Holistic Governance Strategies for Long-Term Care System in Taiwan Government’s Organizational Reform
Ta-Shu Chiang, Kai-Lin Liang
Abstract
'Reinventing the government' is an important governance issue in Taiwan. The Executive Yuan will be restructured in 2012 with three main goals: downsizing the government, enhancing organizational adaptability, and boosting governance effectiveness. Taiwan is a fast aging society. Its government has proposed many social welfare policies for the elderly. A well-known one is the ‘long-term care system’ that has been implemented by the Executive Yuan. However, departmentalism has been a major problem for the long-term care system in the past two decades. “Fragmented government” and “wicked problems” have become main issues in this system. The proposed Department of Health and Social Welfare is a crucial government ministry that is expected to solve existing problems and offer better services to the elderly.
Holistic governance is a new theory in contemporary public administration that offers a critical perspective in this study. “Coordination” and “integration” are core concepts of this theory. By holistic governance, we emphasize strategies of coordination, including toleration of a specific set of institutions, separation and contingency. Finally, we propose five strategies of integration, such as integrating information systems, developing cross-boundary projects, holding regular conferences among central and local governments, changing organizational culture and managing conflicts, and offering opportunities for learning.
Keywords: long-term care system, organization reform, department of health and social welfare, holistic governance