產官學界菁英對於規劃長期照護保險制度之看法－Delphi Technique

Expert's Opinions on Planning Long-term Care Insurance in Taiwan by Delphi Technique

高森永(Sen-Yeong Kao) ； 劉慧蓉(Huey-Rong Liou)

《醫療品質》 3卷1期 (2004/12) Pp. 20-46

https://doi.org/10.29759/HQ.200412.0003

摘要

為提供政府規劃一適合我國長期照護服務體系所需本土性實證資料，本研究採Delphi Technique從學術單位、政府機構及業界等三方面挑選出184位在健康保險與長期照護領域上知名的學者專家、業管的政府官員、及長期照護業界代表等三類菁英群體，以徵得學者菁英對於我國長期照護保險規劃相關問題之看法。在經三回合的問卷調查後，學者菁英代表們對於在規劃我國長期照護保險制度方面已達成以下之共識：
壹、開辦長期照護保險前宜先解決的問題：首須整合社會福利與衛生行政體系、建立協調管道，俾利長期照護保險之整體規劃；其次宜儘速建立管理制度，解決當前諸多問題。
貳、在財源籌措制度方面：建議以成為全民健保附加險是目前較為可行的制度。
參、在財源籌措方式方面：建議以稅收與保險費混合方式較為適宜，且能照顧到其他弱勢族群。
肆、在保險對象界定及保險屬性方面：建議以全民性與強制性較能發揮危險共同分攤及保險大數法則精神，制度易行且減少逆選擇問題產生。
伍、在規劃及主管機關方面：建議以成立獨立跨部會小組為主導規劃及管理相關事宜。
陸、在經營主體方面：建議以公營機構為經營主體，以公辦公營方式辦理長期照護保險。
柒、在給付相關問題方面：建議以身心功能障礙程度合於需長期照護者，不限年齡為給付對象；以護理之家、居家照護、日間照護、養護機構及臨托照護為優先給付的照護型態；以醫療照護、復健、機構式照護、短期臨托、生活照護為應給付的服務項目；以照護服務與現金給付並行為給付方式。
捌、在支付制度方面：建議以論人計酬方式依接受照護人數及其需求程度來支付相關費用。
玖、在費用審核方面：建議以事前審查或事前審查與使用中審查並行為宜。

關鍵字

長期照護 ； 長期照護保險

並列摘要

This study was conducted by ”Delphi Technique” to collect experts' opinions on the issues of planning long-term care insurance in Taiwan. There were 184 representative experts selecting from the long-term care industry, in-charge officers from related government departments (Department of Health and Ministry of Interior), and scholars of related fields. After three rounds of surveying, these experts' opinions on planninglong-term care insurance had reached the following agreements.
1. The most central problem to be solved before implementation of long-term care insurance was to establish joint-administration and coordination channel between social welfare and health care systems.
2. The most feasible financing system was to make long-term care insurance as an additional insurance attached to the National Health Insurance.
3. The most appropriate funding method was to combine general revenues and premiums.
4. The suggested eligible beneficiary was no one excluded. The suggested type of long-term care insurance was mandatory.
5. An independent inter-ministry steering group was strongly suggested as planning and administrating institution of long-term care insurance.
6. Government agency was highly expected to run the long-term care insurance.
7. In the aspect of beneficial party, it is highly agreed that beneficiaries were people with long-term care needs based on evaluation of degree of physical or mental disability regardless of age. The planning long-term care insurance should pay nursing homes, home care, day care, registered care centers, and respite care. In the aspect of service details, medical care services, rehabilitation services, institutional ward fees, short-term respite care, and daily routine service had high degree of agreement. Combination of care services and cash payment had the highest degree of agreement and importance.
8. Among the payments of planning long-term care insurance, capitation had the highest degree of agreement and importance.
9. Pre-review was the most suitable method for fee assessment. Combination of pre-review and ongoing assessment was also highly suggested by these experts.

並列關鍵字

Delphi ； Technique