日本介護保險制度之初探:經驗與啟示
林淑馨
《摘要》
隨著我國人口結構的改變,老化及失能人口快速增加,長期照護需求有快速成長的趨勢。我國長照十年計畫雖始於2008年,但相關討論多圍繞於制度設計,如資金籌措與分配等,加上主管機關散見不同單位,造成服務提供較為完善的縣市多在都會地區,而長照保險也尚停留在規範階段,顯示我國的長照制度仍有相當改進檢討的空間。
反觀日本的介護保險制度自2000年實施至今以來,每隔三年進行一次檢討修正。日本的介護保險是社會保險制度改革的第一步,標榜維護老人自立與尊嚴,有照護負擔公平化、服務提供市場化、長期照護社會化、服務選擇自由化等特色,屬於「有選擇的福利」。
研究結果發現,藉由日本經驗所獲得的啟示有五:1.將公私協力概念融入長期照護政策;2.長期照護制度的推行與地方自治的落實密切相關;3.資訊公開對於政策執行的必要性;4.服務內容應力求簡明化與區域化;5.實物給付為積極性社會福利的表現。
[關鍵詞]:長期照護、長照保險、日本、公私協力、市場化
A Preliminary Study of the Japanese Long-term Care Insurance Act: Lessons for Taiwan
Shu-Hsin Lin
Abstract
With the change of population structure, marked by increases in the elderly and the disabled, the need for long-term care grows rapidly. In 2008, Taiwan launched the Ten-year Long-term Care Plan. However, the discussion of the plan centered on the system design, such as funding and distribution. Also, responsible authorities are spread among different government agencies. As a result, metropolitan areas have received better long-term care services than rural areas. It looks the Long-term Care Insurance Act is still at the planning stage. All these indicate that our long-term care system has much room for improvement.
The Japanese Long-term Care Insurance Act was first implemented in 2000, and has since been revised every 3 years. It is the first step to reforming the social insurance system. It is a “welfare system with choices”- a system that respects the elderly and emphasizes fair expenses, marketization of service provision, socialization of long-term care and liberalization of services choices.
This study identifies the following five lessons for Taiwan from the Japanese experience in seeking a good long-term care system: 1. Public-private partnership can be applied on the long-term care system; 2. Long-term care system is highly related to local autonomy; 3. Information transparency is essential to policy execution; 4. The services provided must be concise and localized; 5. Actual reimbursement is an act of proactive social welfare.
Keywords: long-term care insurance system, Japan, public-private partnership, marketization