長期照顧財政模式的再檢討─兼及於供給面的討論

A Reexamination of the Financial Methods of Long-Term Care:A Discussion from the Supply Side

李德豪(Te-Hao Lee)

指導教授 ： 蔡茂寅

國立臺灣大學/法律學院/法律學研究所/碩士(2022年)

https://doi.org/10.6342/NTU202200342

摘要

隨著高齡化現象的持續進展，長期照顧的任務由家庭轉移到社會來承擔，使得長期照顧成為我國社會保障的最後一塊拼圖，其良窳攸關國民老年生活品質甚鉅，我國在2015年通過長期照顧服務法後，雖曾一度準備以社會保險方式推動長期照顧，然而最後卻逆轉以稅收為財源來推動，但國家財政資源畢竟有限，如何確保長期照顧制度能順利推動，仍是重要議題。

因此，本文擬藉由分析長期照顧在我國其制度面與財政面的生成與發展，以及檢討長期照顧現存機制下國家－長期照顧服務機構－長期照顧使用者的三方法律關係，並回顧長期照顧服務法後施行至今在財政面上的發展，來探討現行制度的妥適性。

然而，長期照顧制度在財源面上存有既有財源收入不足以之支應支出，且該等收入均有財源安定性不足，以致於未來需仰賴政府預算撥補之問題。面對不斷成長的長期照顧需求與支出，財源面的不安定問題將成為揮之不去的陰霾。為改善此一問題，本文認為此時應重新審視、檢討採取社會保險方式推動長期照顧的可能性，以確保長期照顧的制度能夠永續。

關鍵字

高齡化社會 ； 長期照顧 ； 社會保險 ； 長期照顧服務法 ； 長期照顧保險

並列摘要

With the constant progress of the aging society, the whole society is now responsible for the tasks of Long-term Care which used to be shouldered by the patients’ families. Although Long-term Care was originally scheduled to be promoted through the method of social insurance after the enforcement of the Long-term Care Services Act in 2015, it ended up being pushed forward by the tax revenue. However, the problem of how to guarantee a successful promotion of Long-term Care arises because of the limited resources of state revenue and expenditure and thus becomes a debatable issue.

In this study, the author tried to analyze the beginning and development of Long-term Care from both institutional and financial aspects in Taiwan and aimed to examine the tripartite legal relationship among our country, Long-term care service institution, and the Long-term Care services users and further inspect the appropriateness of current system by reviewing the practice of Long-term Care Services Law financially from the very beginning to the present.

Nonetheless, from the financial aspect, not only the insufficient revenues but also the unstableness of incomes has led to the possibility of depending on the allocation from the government in the future. Faced with the perpetual demands and expenses of Long-term Care, the problem of financial unstableness will surely bring about several difficulties for the promotion of the law. To solve the problem, in this study, the author suggested that it is time to re-examine and review the possibility of adopting social insurance to promote Long-term Care for the purpose of ensuring the sustainability of the Long-term Care system.

並列關鍵字

Aging society ； Long-term Care ； Social Insurance ； Long-Term Care Services Act ； Long-term Care Insurance

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