兩岸長期照護政策及保險制度之比較研究

A Comparative Study of Long-Term Care Policies and Insurance Systems Across the Taiwan Straits

趙忠傑(Chao, Chung-Chieh)

《兩岸企業社會責任與社會企業家學術期刊》 5期 (2020/03) Pp. 18-52

摘要

2017年聯合國世界人口展望報告，以「全球老齡化趨勢難逆轉」為題，報告中預估2050年全球65歲以上高齡人口將超過現今的兩倍以上，2100年則可能成長到31億。在亞洲國家，人口老化問題格外令人擔憂，目前全球人口老化速度，前四位均位於亞洲，且從預估資料看來，中國人口老化的速度也在逐年攀升，約在2050年中國也將邁入超高齡社會，並擁有3.37至4億的老年人口。人口結構的改變與快速老化，影響到許多層面的議題，且為健保醫療、養老長照和相關社會保障，帶來可觀的財政與政治壓力，甚至引發國家層級的安全問題。長期照護政策，就好比預先張開的保護傘，包括長照人力的供需、社會保險的規劃、市場與產業鏈的串聯、維護老年權益、以及完整的長期照護體系（Long-Term Care, LTC）的塑造。面對來勢洶洶的人口老化，本研究著眼於特殊的亞洲脈絡，以中國與台灣作為研究對象，希望藉由兩個亞洲個案國家相關政策及保險制度的資料收集、分析比較，歸納出與實務緊密連接的精進方案與政策建議，提供各國尤其是亞洲國家在推展相關政策時做參考。本研究採比較研究方法（comparative study），首先以長期照護為題，蒐集中國與台灣長照發展與現況的文獻，接續透過後設資料分析提出比較項目，再將資料歸類及並列呈現，最後進行比較分析與討論。研究發現，中國與台灣雖然在各方面差距甚大，且人口結構老化的時序也相差不少，但在老年化的速度、失能比率、非機構式照護比例，都非常相似。在政策與制度面，兩國長照政策的起步時間相近，但中國長照制度的覆蓋率遠低於台灣，雖然給付的項目無差異，但在長照給付方面，台灣約高出中國六倍。整體而言，台灣的長照制度設計相對統一且周全，而中國明顯缺乏上位計劃的規範，但長照產業的發展與政策無法對接、長照服務供給不足存在結構性問題，則是兩國長照政策共同面臨的障礙。

關鍵字

人口老化 ； 長期照護 ； 保險制度

並列摘要

According to ＂World Population Prospects: The 2017 Revision＂, printed by the UN Department of Economic and Social Affairs, the population aged over 65 years old in 2050 will be 2 times more than the population today, and in 2100, it will increase to 3.1 billion. The situation of the aging population is more worrisome in Asian countries because the top 4 fastest increasing rate of aging population in the world is in Asia. Moreover, the aging population in China is growing faster year by year. China will be an super-aged society in 2050, and the population of the elderly will be around 337 million to 400 million. When the population gets aging, it will affect many issues in the society. Meanwhile, it will increase the pressure of health care, long-term care and social benefits in terms of finance and politics. Furthermore, it is possible to become a problem of the national security. The policy of long-term care, as the prevention of the pressure mentioned above, provides the supply of care staff, the plan of social insurance, the collaboration of the market and industry chain, and the shaping of complete long-term care (LTC). The study bases on the unique context of Asia and conducts research on China and Taiwan. It aims to provide some practical suggestions for policies especially in Asian countries to improve by collecting, analyzing, and generalizing the data from the case study on policy and insurance systems. The study uses comparative study. First of all, it reviews the literature regarding the development of long-term care in China and Taiwan. Next, it sets up the items comparing based on the metadata. It then categorizes and lists the data. Finally, it analyzes the data and discusses the find-out. Regarding the speed of aging, the ratio of incapacitation, and the proportion are similar between China and Taiwan, although there is a disparity between these two, and time sequence of aging population is different as well. Moreover, regarding the policy and system of long-term care in these 2 countries, the starting time is similar; however, the coverage of China is six times lower than Taiwan, even though the benefit package is similar between China and Taiwan. Overall, the system in Taiwan is relatively unified and thoughtful. On the other hand, China has a lack of a qualified program. Meanwhile, China and Taiwan have the same obstacles from the perspective of the gap between the long-term care industry and the policy, and the structural issues in the inadequate supply of long-term care.

並列關鍵字

aging populations ； long-term care ； insurance