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  • 學位論文

台灣長期照護保險之策略規劃-財務、人力與服務觀點

Strategy Exploration of Long-Term Care Insurance in Taiwan-Finance, Human Resource and Service Point-of-Views

指導教授 : 黃崇興 李存修

摘要


隨著總生產率下降、人口成長率下降與平均餘命的延長,台灣的65歲以上老年人口早於民國82年達到人口老化國家門檻的7%,預計民國107年達高齡社會的14.7%,民國117年達超高齡社會的22.5%。伴隨人口結構的快速高齡化、家庭照顧功能的消失與失能失智人口的增加,以生活照顧而非醫療治病為主的長期照護(長照)保險制度即將成為我國社會福利的另一主幹。 從目前我國長照保險規劃報告,我們可以歸納以下的重點。長照的對象應該是65歲以上日常生活與工具性日常生活失能的老人、失智者與身心障礙者。長照的納保原則上會比照健康保險,以全民為對象。長照的傳遞,將由相關之保險局負責從申請、訪視評估與需求判定,而照顧計劃之擬定以及執行則希望由地方政府完成,以達因地制宜效果。財務規劃上,根據實際調查預估之失能人口、照護分級(需支援、需照護一、二、三級)以及現今十年長照計劃使用率,民國100年,110年及120年之高推估保險總費用將達GDP之0.75%,0.97%及1.25% (低推估為0.36%,0.46%及0.61%),但是給付卻上限遠低於德國、日本,甚至南韓。 針對這份長照保險草案,個人認為可以從服務策略看到在未來長照服務執行上,確實存在顧客期望差距的知識缺口、自以為是的標準訂定缺口、實務輸送服務的輸送缺口、服務提供與行銷的溝通缺口乃至可能的顧客實際感受差距的服務缺口。其中,尤其是服務提供人員的素質、訓練與理念奠定,將是長照服務能否成功的關鍵。為求補強服務策略分析上的弱點,個人認為可以從照服員與照管專員等第一線人員的專業訓練課程標準化與在職評估制度化,來強化人力資源。財務規劃上,更須依照工作內容與實際付出,提昇給付上限與支付標準,強化長照從業者的工作尊嚴與工作控制感,清晰其社會角色地位,當更有助於我國未來推動全面的長照保險。

並列摘要


Longterm care insurance has become on inevitable taskforce for the government in Taiwan, owing to the world lowest birth rate, extension of life expectancy, disappearance of family care function and exaggerated growth of the disabled and the populations. Longterm care insurance provides daily life function support, which contrasts greatly from the disease therapy in health insurance system. From the preliminary report of Taiwan Longterm Care Insurance Project, we can understand the detailed planning of the future insurance system. The contents describe the service receiver, service delivery, insurance coverage, finance resources as well as potential finance problems. Analysis from finance, human resource and service point-of-views clearly delineate the future challenge. Finance planning has to facilitate better home care and local care quality by high-level payment. Without cost-beneficial payment, longterm care service will face first line service failure and unexpected role stress for service providers. Human resource has to build up a standardized training program with systematic on-job monitoring of all performance. With standardized program, all service providers will be able to follow a properly credited tract. From service point-of-view, we should evaluate the structure of training and performance systematically via strategic service vision steps. Meanwhile, we should repercuss all potential knowledge, standard, delivery, communication and service gaps to our customers, which apparently will emerge following the execution of the Longterm Care Insurance Project. Knowing what we have, thinking what we miss and make up what we know to be missed are the attitude we should own for the realization of Longterm Care Insurance in Taiwan.

參考文獻


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被引用紀錄


翁良綺(2015)。我國長期照護政策對個人影響之初探〔碩士論文,淡江大學〕。華藝線上圖書館。https://doi.org/10.6846%2fTKU.2015.00669
柯姿婷(2015)。長期照顧機構經營策略之研究–以臺北市小型長期照顧機構為例〔碩士論文,淡江大學〕。華藝線上圖書館。https://doi.org/10.6846%2fTKU.2015.00388
廖慧媛(2012)。長期照護經營管理關鍵成功因素之研究一以A長期照護中心為例〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.00514

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