台灣多層次長期照顧財務保障架構之探討

Financing Long-Term Care in Taiwan: A Multi-Tier Approach

周台龍(Tai-Lung Chou) ； 鄭文輝(Wen-Hui Peter Cheng)

《臺灣社會福利學刊》 7卷1期 (2008/08) Pp. 65-122

https://doi.org/10.6265/TJSW.2008.7(1)3

摘要

本文提出一個公、私部門合作共同分攤財務責任，兼顧公平、風險分攤與自我負責的多層次長期照顧財務保障架構，來整合家庭、市場及政府的財務資源。第一層爲社會保險制度，第二層爲商業保險，第三層爲個人自付額。本文首先從公平和效率的角度探討建立長期照顧制度的必要性，其次說明多層次長期照顧財務保障架構的內容，繼則分析此多層次長期照顧財務保障架構的可行性，最後利用財務數字來模擬分析公、私部門在此財務保障架構中適當的分工問題。
模擬分析結果顯示此一財務保障架構應爲可行：(1)以長期照顧社會保險制度，提供第一層的基本給付水準保障；(2)在單純考慮家庭可支配所得的情況下，中、高所得家庭有能力購買商業保單來補充保障水準，享受適當或優質的長期照顧服務；(3)如果加入不動產反抵押融資的方式，則有助於提高所有家戶長期照顧需要者的保障水準。本文建議政府應積極規劃長期照顧社會保險，鼓勵商業保險公司開發合適的保單，並探討不動產反抵押的市場需求潛力和供給面的障礙，研擬相關法律規範，鼓勵銀行提供長期照顧所需貸款，進而創造不動產反抵押的市場，活用房地產資源來減輕家庭長期照顧的財務壓力。

關鍵字

多層次 ； 社會保險 ； 商業保險 ； 不動產反抵押

並列摘要

To meet the rapidly increasing need of long-term care in Taiwan, the government is urgently called to develop a formal public long-term care system which may lessen the care burden of the family and also upgrade the quality of care. This study aims to investigate the system design and the feasibility of estabishing a multi-tier package of public-private financial framework for long-term care in Taiwan, which includes a basic coverage of social insurance, supplementary private insurance policy and home equity reverse mortgage mechnism.
Methodologies: Rationales for developing a multi-tier financial framework of long-term care will be first explored under Taiwan's socioeconomic context. Then, the elements of system design will be analyzed from aspects of equity and efficiency. Finally, empirical evaluation of implementing such a package of financial arrangement will be made by simulation approach with relevant assumptions and data set, such as projection for future need and expenditure of long-term care in 2006-2031 and household income and expenditure survey.
Major findings: (1) Providing basic long-term care coverage for all people through social insurance program is appropriate and feasible in Taiwan; (2) Home equity reverse mortgage scheme may be quite helpful for upgrading the benefit level of long-term care service by either paying out-of -pocket expenses or buying private insurance policy.

並列關鍵字

Multi-tier ； social insurance ； commercial insurance ； reverse mortgage

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Linking Reverse Mortgage and Long-Term Care Insurance

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