日本介護契約委託制度之現況與挑戰
申育誠
《摘要》
本文研究目的主要探討日本在高齡化的社會問題影響下，日本政府期待實施介護保險制度，並藉由介護契約委託制度，以提供多元的福利服務，解決目前高齡者的照護需求。因此，本文透過學者專家的相關著作及日本厚生勞動省的官方資料，進行文獻分析。主要針對（一）日本介護保險制度實施沿革，（二）介護保險法與社會福利法下的契約制度，（三）標準化服務契約的實務案例及契約書重要事項，（四）介護支援專門員協助高齡者簽訂介護契約的實務案例，進行論述。
最後，本文研究發現指出，日本長期照護的福利服務體系之契約委託制度所強調的是資訊公開，妥適向被保險人說明契約內容，以提升政府施政的行政效能為介護契約委託制度的主要核心價值。另外，針對我國長期照護的啟示則包括：重視契約內容及重要事項的說明，並明確化及撰寫重要事項說明書的同時，強調「使用者本位」的福利服務模式，以及定位「介護支援專門員」的角色，並解決介護契約委託制度所產生的服務使用者與業者之間對於介護契約內容的「資訊落差」問題，以兼顧介護服務的「量」與「質」為重要的特色。
[關鍵詞]： 介護保險、政府效能、契約委託制度、福利服務
The Current State and Challenges of the Long-term Care System in Japan
Yu-Cheng Sheng
Abstract
The research objective of this study is to explore the Japanese government’s anticipated implementation of the Long-term Care Insurance System to put the nursing contract system into practice and provide diversified welfare services to cater to the current needs of elderly care as the problem of aging population grows. This study mainly explores the contract system for enhancing the government’s administrative efficiency and establishes a complete long-term care insurance service system. The following are also discussed: (1) The historical background of implementing the Long-term Care Insurance System in Japan; (2) The analysis of the contract system stipulated in the Long-Term Care Insurance Act and the Social Welfare Act; (3) The implementation case studies of the standardized service contract and key points of the contract; (4) Implementation cases of long-term care support specialists in assisting the elders to sign the contract.
Finally, it was found that the contract system under Japan’s long-term care welfare service system emphasizes information transparency and an appropriate explanation of the contract contents to the insured in order to enhance the administrative efficiency of government policy, which are the core values of the care contract system. In addition, its lessons to Taiwan’s long-term care include: emphasizing not only contract contents and an explanation of important matters, but also stressing the “user service-based” welfare service model and positioning the role of “long-term care support specialists” while clarifying in writing important points of the contract. Taiwan can also learn from Japan how to resolve the issue of an “information gap” in the care contract content between the service user and the service provider arising from the care contract system, taking into account the importance of both the “quantity” and “quality” of care services.
Keywords: Long-term Care Insurance, government efficiency, contract system, welfare services