促參採有償取得公共服務(有償PPP)模式之「比較價值成本」分析架構：以長期照顧服務為例

全球人口快速高齡化，臺灣也不例外，自1993年起已達聯合國世界衛生組織所定義的高齡化社會(Ageing Society)之標準，65歲以上老年人口比率達7.1% (149萬801人)，於2018年達14.6% (343萬3,517人)，成為「高齡社會」(Aged Society)，至今，老年人口比率持續攀升，幼年人口(0-14歲)比率持續下降，截至2020年12月底，65歲以上人口所占比率為16.07% (378萬7,315人)，0-14歲人口所占比率為12.58%(296萬3,396人)，「老化指數」自1993年28.24%一路升高至2020年127.80%。依行政院國家發展委員會對未來人口推估資料顯示，臺灣2025年將達到20.1% (470萬人)成為「超高齡社會」(Super Aged Society)。隨著老年人口快速成長，慢性病與功能障礙的盛行率將急遽上升，相對的失能、失智人口也將大幅增加，其長期照顧需求與負擔也隨之遽增。依據衛福部長照專區於109年12月之統計，長期照顧推估需求人數全臺為824,515人，實際服務人數為450,968人，服務涵蓋率約54.69%，其顯示長期照顧服務率尚有不足。面對高齡化社會產生長期照顧服務之迫切需求，如何加速布建長照機構，提供更全面、完善及優質之長期照顧服務，係當前政府面臨重要課題。長期照顧服務屬低自償性、高公益性需求之公共建設，政府應編列基金預算辦理並鼓勵民間參與，且因應長期照顧之大量需求且建構不易又有迫切性，有賴政府及民間公私合力投入，滿足未來高齡化社會長期照顧服務需求。 PFI（Private Finance Initiative）模式係民間參與公共建設其中一種方式，翻譯上亦有稱之為「民間財務提案制」或「民間財務啟動制」等。PFI就其概念而言與Public-Private Partnership（PPP）與我國促參之概念無異，但因英國PFI一詞由英國而出，且英國PFI促參制度均採有償取得公共服務方式，故英國PFI一詞在實務上常被定義為有償取得公共服務模式。為正名之故，本研究將英國採行之PFI稱為「英國PFI」、「有償取得公共服務」、或「有償PPP」。英國PFI模式係政府與民間機構以長期契約約定，由民間機構負責投資公共建設興建及營運，且公共服務必須符合約定品質，政府則依英國PFI契約付費予民間機構以購買該建設之公共服務，興建成本與風險由民間機構承擔，政府則負責支付營運費用，屬穩定型的費用收費方式，民間機構因此可避免營運風險。英國PFI制度雖常用於財務自償率低的公共建設，但不以財務自償率低為條件，其適用對象需經較嚴格之分析，即所謂Value for Money（VfM）分析，中文有稱「物有所值」分析，本研究稱之為「價值成本」分析，即價值是否與成本相匹配，達到所要求之成本效益標準。本研究主要初步建立臺灣適用之有償PPP計畫，分為三階段，第一階段是提出之分析架構與流程詳細說明各階段分析之內容與方法；第二階段討論「有償PPP適用建設類型之政策評估」方法；第三階段討論「有償PPP適用建設類型之政策評估」中之需進行之「有償PPP定量評估」之方法論。並以長期照顧服務案例對本研究所建置之「有償PPP之比較價值成本(CVfM)分析」進行驗證。

關鍵字

促進民間參與公共建設；英國PFI ； VFM ；民間融資提案；公帑節省價值；公私協力；長期照顧

並列摘要

The global population is rapidly aging, and Taiwan is no exception. Since 1993, it has reached the ageing society standard defined by the United Nations World Health Organization. The proportion of elderly people over 65 has reached 7.1% (1,490,801). It reached 14.6% (3.433,517 people) in 2018 and became an "aged society". So far, the ratio of the elderly population has continued to rise, and the ratio of the young population (0-14 years old) has continued to decline. As of the end of December 2020, 65 The proportion of people over the age of 16.07% (3.787315 people) and the proportion of people aged 0-14 is 12.58% (2.963396 people). The "aging index" has risen from 28.24% in 1993 to 127.80 in 2020. %. According to the estimates of the future population by the National Development Commission of the Executive Yuan, Taiwan will reach 20.1% (4.7 million people) in 2025 and become a "Super Aged Society." With the rapid growth of the elderly population, the prevalence of chronic diseases and dysfunctions will rise sharply, the relative disabled and demented population will also increase significantly, and their long-term care needs and burdens will also increase dramatically. According to the statistics of the Minister of Health and Welfare in December 109, the estimated number of long-term care needs in Taiwan is 824,515, and the actual number of people served is 450,968. The service coverage rate is about 54.69%, which shows that the long-term care service rate is still insufficient. In the face of the urgent need for long-term care services in an aging society, how to accelerate the establishment of long-term care institutions to provide more comprehensive, complete and high-quality long-term care services is an important issue facing the current government. Long-term care services are public constructions with low self-compensation and high public welfare needs. The government should prepare a fund budget for handling and encourage private participation. In response to the large demand for long-term care, the construction is difficult and urgent. It depends on the joint efforts of the government and the private public.To meet the long-term care service needs of the aging society in the future. The PFI (Private Finance Initiative) model is one of the ways in which the private sector participates in public construction. In translation, it is also called the "private finance proposal system" or the "private finance initiative system". In terms of its concept, PFI is no different from the concept of Public-Private Partnership (PPP) and China's participation promotion. However, because the term PFI in the United Kingdom originated from the United Kingdom, and the PFI promotion system in the United Kingdom adopts a paid public service method, the United Kingdom The term PFI is often defined in practice as a mode of obtaining public services for a fee. For the sake of name recognition, this study refers to the PFI adopted in the United Kingdom as "British PFI", "Paid Access to Public Services", or "Paid PPP". The British PFI model is a long-term contract between the government and the private organization. The private organization is responsible for investing in the construction and operation of public construction, and the public service must meet the agreed quality. The government pays the private organization to purchase the public service of the construction in accordance with the British PFI contract. Construction costs and risks are borne by private organizations, while the government is responsible for paying operating expenses. This is a stable fee collection method, so private organizations can avoid operating risks. Although the UK PFI system is often used in public constructions with a low financial self-compensation rate, it is not subject to a low financial self-compensation rate. Its applicable objects require a more rigorous analysis, the so-called Value for Money (VfM) analysis, which is called " "Value for money" analysis is called "value cost" analysis in this study, that is, whether the value matches the cost and meets the required cost-effectiveness standard. This research mainly preliminarily establishes a paid PPP plan applicable to Taiwan, which is divided into three stages. The first stage is the proposed analysis framework and process to explain in detail the content and methods of each stage of analysis; the second stage discusses "Policies applicable to construction types of paid PPP Evaluation method; the third stage discusses the methodology of the "quantitative evaluation of paid PPP" in the "Policy Evaluation of the Type of Construction Applicable to Paid PPP". The "Comparative Value Cost (CVfM) Analysis of Compensated PPP" established by this research is verified by long-term care service cases.