長照社會成本與社會效益之推估：以埔里基督教醫院小規模多機能中心為例

高齡化社會所面臨的挑戰是高齡化人口結構的產生，各國對於長期照護的需求與日俱增，長照資源的投入以及分配，都是國家福利政策的主要議題。本研究主要目的，希望透過個案的長照機構的財報數字評估長期照護，對整體社會所帶來的成本與效益。本研究以埔基醫療財團法人附設南投縣私立常樂社區式長期照顧服務機構為研究個案，參考 Schalock and Butterworth (2000) 的社服機構成本效益分析模式規畫本研究的分析模型，本研究的適用模型將包含受照顧者、長照機構、受政府補助金額、受照顧者的家屬之私人觀點，以及彙總私人觀點而得之社會觀點進行分析。研究結果發現，雖然從私人觀點分析發現長照中心的收入僅盈餘64萬元左右，但如果從社會觀點來看，其所創造的社會效益達到1,385萬元，這部分來自於可衡量的外部效益，如果考量家庭的生活品質、創造就業機會(長照人力)、提升經濟產能(主要照顧者投入經濟活動)、以及增加社會穩定等間接與無形效益的話，那其產生的社會效益將更加巨大。成本的部分，以本研究個案機構為例，針對長照服務的收入，有85%是來自於政府對受照顧者的補助，對於照護家庭而言，可以減輕較多的負擔，政府補助了337萬元左右，但是創造的社會效益卻高達1,385萬元，創造了將近政府補助支出的5倍效益。綜上所述，整體社會觀點下的長期照護機制對於社會整體效益而言是大於其成本的，因此給予政府對於長期照護的補貼政策支持有正當性理由，但如果以成本與效益相比，對於長照機構而言卻未必具有持續提供服務的誘因，未來如何刺激具有提供長照服務能力之機構投入經營，則是政府未來應該思考的議題。

關鍵字

長期照護；社會觀點；私人觀點；成本效益分析

並列摘要

The challenge facing an aging society is the emergence of an aging population structure and the increasing demand for long-term care in various countries. The investment and distribution of long-term care resources are the main issues of national welfare policies. The main objective of this study is to assess the costs and benefits of long-term care to the community as a whole through the financial figures of the long-term care institutions. This study took Nantou County private Changle Community long Term care service Institution attached to Puli Christian Hospital as a case study. The analysis model of this study was formulated by referring to Schalock and Butterworth's (2000) cost-benefit analysis model of social service institutions. The applicable model of this study included the private views of the caretakers, the institutions of long-term care, the number of government subsidies, the caretakers' family members, and the social views derived from the aggregate private views. The research results show that although the income of the long-term care Center is only about 640,000 yuan in the surplus from a private point of view, from a social point of view, the social benefits it has created reach 13.85 million yuan, which is partly from measurable external benefits. The social benefits are even greater when indirect and intangible benefits such as quality of life for families, job creation (long-term manpower), increased economic productivity (primary caregivers are engaged in economic activity), and increased social stability are considered. As for the cost, take the case institution of this study as an example. 85% of the income of long-term care services comes from the government's subsidies to the recipients, which can reduce the burden of caring for families., The government-subsidized about 3.37 million yuan, but the social benefits were as high as 13.85 million yuan, creating nearly five times the benefits of government subsidies. To sum up, the long-term care mechanism under the overall social perspective is greater than its cost for the overall social benefits. Therefore, there are legitimate reasons for granting government subsidy policy support for long-term care. However, if the cost and benefit are compared, it is As far as long-term care institutions are concerned, they may not have the incentive to continue to provide services. How to stimulate institutions capable of providing long-term care services to operate in the future is a topic that the government should consider in the future.