台灣住宿型長照機構之市場結構與品質誘因

過去台灣僅50床以下住宿型長照機構可私人營利，其他為公益性的社團法人和非營利性的財團法人，使機構缺乏提高品質的能力或誘因。2018年開放非公益性社團法人得以進入市場，但市場的供給誘因仍有限。本文分析住宿型長照機構的市場結構，並整理相關文獻探討規模、權屬別的影響，以及誘使品質提升之市場機制。文獻顯示住宿型長照機構有規模經濟特性，規模擴大可降低平均成本。此外，市場充分訊息可降低供給者的市場壟斷力，擺脫規模或權屬別限制的必要性，並使消費者獲得市場競爭的效益。評鑑的角色為公開品質資訊，透過消費者的選擇效果，以市場競爭促使品質提升。但評鑑亦可能強化高品質供給者的市場壟斷力而提高價格，因此評鑑等級宜確實反映照護品質。

關鍵字

長照機構；照護品質；市場結構；評鑑機制

並列摘要

Previously, the Senior Citizens Welfare Act only allowed nursing homes with less than 50 beds to operate for profit, while others had to operate as non-profit institutions. Although size or ownership restrictions prevented providers' from becoming monopolistic, it also mitigated their ability to pursue higher service quality. Therefore, in 2018, for profit institutions w ere allowed to enter the market; however, supply incentive for the market was still weak. A review of relevant literature shows that nursing homes can benefit from economies of scale. Therefore, expanding their scale can reduce the cost of providing high-quality services. Moreover, sufficient market information could reduce the monopolistic power of providers and release the necessary of scale and ownership restrictions. The primary mechanism for accreditation to improve quality is to disclose information regarding care quality. The disclosure of nursing homes' care quality can facilitate consumers' smart decision, thereby inducing market competition. However, accreditation may enhance top-ranking providers' monopolistic ability to raise prices and thus the assessment of care quality should reflect the clinical outcomes of care.