國家擔保責任於長期照護之實現

The Responsibility of Government in Long-term Care Legal Scheme

陸敏清(Ming-Cing Lu)

指導教授 ： 郭介恆

國立臺北大學/法律學院/法律學系/博士(2010年)

摘要

我國自民國82年起即已達世界衛生組織所定「高齡化社會」的門檻，也隨著老年人口的增加，照護議題成為國家亟待解決的重要課題，綜觀世界各國對於長期照護的發展走向，均朝著據此衍生的「照護」需要而努力。事實上，長期照護的精神在於提供失能者日常生活照顧甚至是醫療處置，藉此降低老年或疾病對其身心所造成的不便，不過面對過去可由個人或家庭承擔的照護需要，在環境變遷下漸難以為繼，進而產生「外化」處理的訴求，特別在受到民營化、政府組織再造等改革的影響，除造就國家角色及任務的遞嬗外，也連帶影響照護政策的走向。

事實上，如何吸納私人力量進入政府公部門協助，甚至替代其執行任務，已成為各國的重要課題，而在長期照護領域上亦仰賴整體社會的協力，從而會成就出「社會化」的面貌，只是此等新發展契機無疑仍須通過憲法秩序的檢驗；此外，如何將其置於傳統國家卅社會的二分架構的基礎上對其加諸若干調控？自然會是國家在踐行其擔保責任的一大挑戰，為確保得以發揮成效，在制度建構上自須以法規範作為後盾，據此，本論文嘗試在此一脈絡下引導出憲法秩序所塑造的規範依據，一方面讓國家各該作為受到法治國家的拘束，同時也確保國家在各種決定上所斟酌的相關資訊與利益能合乎社會正義，進而在回應長期照護的擔保責任上，國家除透過法令的他律控制，在往昔的管制措施外，更需借助諸如給與補助、獎勵或提供資訊的助長措施，乃至於契約課責的對話機制。有鑑於今日對於長期照護法制的殷切期盼，考量其未來願景與發展性，本論文除將檢視我國現行法制的發展，並試以比較法分析，冀望師法他國實施經驗以供我國調控上之借鑒。

關鍵字

長期照顧（護） ； 國家調控 ； 擔保國家

並列摘要

The old age population in Taiwan had reached the level defined by WHO since 1993, and this trend will increase the possibility of body and mind handicapped. In the past, people who have Long- Term Care (LTC, Pflege) needs always handled by individual and family, but right now it will become a social problem, therefore; the issues of LTC have become more and more discussed.

From the Constitution law and the principle, reveals that government not only has the duty to ensure people’s minimum lives quality, but also arranges it by law. However, with the evolution today, it pushes governments to reform themselves. Today, how to attract private-sector access into government agencies, even implement LTC mission, has become more and more important, however, even though these new attempts bring some benefits, but they still have shortcomings, so “how can we apprehend it and solve the dilemma?” In other words, how to govern in LTC field? Is a challenge today. According to this thought, this thesis tries not only to observe the shape by the norms of the constitution and makes the LTC system ruled by law, but also ensure the governance means in connection with LTC’s core characteristics.

In fact, outsourcing, cooperation have applied broadly in LTC field, but to the contrary, how should we maintain the efficiency and quality of LTC services? It involves not only regulation measure, but also some relative measure, like contract accountability, subsidy or information incentives etc. This thesis also attempts to evaluate correctly by means of all mechanism and take comparative analysis to provide some advices for the constitution of LTC legal scheme in the future.

並列關鍵字

Long-term Care ； Governance

參考文獻

1. 王振寰、瞿海源編，社會學與台灣社會，巨流，1999年。

2. 王振寰，全球化、在地化與學習型區域：理論反省與重建，臺灣社會研究，第34期，頁69-112，1999年6月。

3. 江明修、梅高文，自律乎？他律乎？–財團法人監督機制之省思，中國行政評論，第12卷第2期，頁137-160，2003年3月。

10. 吳淑瓊，人口老化與長期照護政策，國家政策季刊，第4卷第4期，頁5-24，2005年12月。

11. 呂寶靜，支持家庭照顧者的長期照護政策之構思，國家政策季刊，第4卷第4期，頁25-40，2005年12月。