我國實施長期照護保險之可行性評估

Feasibility of Introducing Long-Term-Care Insurance in Taiwan

鄭文輝(Wen-Hui Peter Cheng) ； 鄭清霞(Ching-Hsia Cheng)

《國家政策季刊》 4卷4期 (2005/12) Pp. 69-92

https://doi.org/10.6407/NPQ.200512.0069

摘要

本文從政策考量、制度設計與財務負擔等三方面評估我國實施長期照護保險的可行性，並探討整備事項的充實，進而提出規劃長期照護保險的建議事項。
本文的主要發現有下列兩項：
（一）雖然我國老人比重目前將近10%，較德國與日本規劃長期照護保險時為低，然預計未來老化速度較兩國為快，且穩定財源的取得有助於服務提供的開發，因而現階段宜積極規劃長期照護保險。
（二）依本文基本推估，2006-2046年期間我國日常生活活動功能障礙者所需長期照護費用占GDP的比重，約在0.48%至0.57%之間。2006年四口雙薪家戶的長期照護保險費平均約為家戶每月可支配所得的0.37%，而加計勞保與健保保費約占家戶每月可支配所得的3.81%。至於政府補助四成保險給付，約占2006年中央政府總預算的1.17%，而為中央政府社會福利支出的6.31%。上述初步評估顯示，財務負擔並非規劃我國長期照護保險時必須考量的最主要問題；更重要的是，現行服務輸送體系的健全與管理機制的建制，以及人力的培育都須努力補強，方可望順利實施長期照護保險。
針對我國長期照護保險的規劃，提出下列五項原則性的建議：
（一）及早明定政策走向，進行規劃並充實人力、物力整備。
（二）明確界定照護需要性，並訂定一致性需要評核機制。
（三）提供普及性基本保障，依需要程度訂定給付上限。
（四）實施多元照護服務，允許照護需要者自主選擇。
（五）建立適當照護管理機制，有效運用資源。

關鍵字

長期照護 ； 長期照護保險 ； 長期照護費用估算

並列摘要

This paper aims to evaluate the feasibility of introducing Long-Term Care (LTC) Insurance in Taiwan, from the aspects of policy consideration, system design and financial burden. The relevant prerequisites for implementing LCT insurance are also explored. Thus, the suggestions for planning feasible LTC insurance program in Taiwan can be derived.
Major findings from this study are two-fold:
(1) The current percentage of elderly in total population is about 10% in Taiwan, which is less than those in Germany and Japan when their LTC insurance programs were under planning. Nevertheless, Taiwan is experiencing aging more rapidly than these two countries and stable financing may enhance the development of resources in the future, thus now is the right time for planning LTC insurance in Taiwan.
(2) According to medium estimate, the share of long-term care expenditure in GDP during 2006-2046 will be between 0.48% and 0.57% and the burdens both on families and on government budget are expected to be bearable. However, to implement the insurance program in Taiwan, wholesome delivery system and various professional and semi-professional care workers should be well prepared.
Five guiding principles for planning LTC insurance programs can be derived from this study: (1) Determining the policy orientation of the LTC system, undertaking the planning process and also enhancing service resources as soon as possible; (2) Clearly defining the need of long-term care and applying uniform need assessment national-wide; (3) Providing universal but basic benefits with various ceilings for different care needs. (4) Allowing autonomy in service choices for various service provision; (5) Applying appropriate care arrangement system.

並列關鍵字

long-term care ； long-term care insurance ； projection of long-term care expenditure