韓國老人長期照顧保險服務輸送之實施經驗：對我國的啟示

The Implementation of Long-term Care Insurance and Service Delivery in South Korea: A Reference for Taiwan

韓國與我國社會文化背景及人口發展脈絡相似，同樣面臨嚴峻的人口老化與長期照顧議題，自2008年實施長照保險迄今逾6年，其師法德、日後設計的服務輸送模式與實施經驗值得我國參考。本研究以文件歸納與實地訪談了解韓國老人長照保險發展與制度實施情形，說明韓國採單一保險人制度，運用職員進行需求評估，評估結果交付認定委員會進行給付資格認定，並提供受益者利用支援服務，以強化其選擇服務及監管服務品質。有關制度規劃與實施情形的說明，包括保險人服務輸送架構、服務輸送五個步驟與利用支援、以及保險人對職員及認定委員會委員的人力運用與管理。文末就韓國長照保險實施經驗對我國的啟示意涵提出四點省思：一、規劃品質與效率兼顧的服務輸送架構及人力配置；二、研擬兼顧公平與效率的照顧需求認定模式；三、整備長期照顧資源與品質監管並進；四、建立保險人與服務提供機構分工合作的服務輸送模式。

The sociocultural background and population growth in South Korea are similar to those in Taiwan. Moreover, both South Korea and Taiwan are experiencing problems related to population aging and long-term care provision. Six years have passed since the government of South Korea implemented the long-term care (LTC) insurance for senior citizens in 2008. The approach that the South Korean government adopted referenced and integrated German and Japanese service delivery models, which can serve a valuable reference for Taiwan. In this study, we conducted a literature review and field interviews to understand the development, progress, and implementation of the LTC insurance for senior citizens in South Korea. In South Korea, a single-payer system is used, and the National Health Insurance Corporation (NHIC) assesses the LTC care needs of beneficiaries. The assessment results are submitted to an LTC Needs Certification Committee (LTCNCC) that determines whether beneficiaries are eligible to receive insurance payments and access to support services, thereby facilitating the beneficiaries' selection of services and monitoring the quality of the services provided. In this study, we describe the planning and implementation of the insurance system, including the service delivery framework for insurers, the 5 steps of the service delivery process, the utilization of support services, and the NHIC's human resource management practices regarding the associated LTC staffs and the LTCNCC members. Finally, based on the implication of South Korean LTC insurance system design and implementation for Taiwan's planning of LTC insurance service delivery system, we recommend the LTC insurers in Taiwan to (a) plan a service delivery framework and human resource allocation model that consider both quality and efficiency, (b) develop a model for LTC needs certification that simultaneously considers fairness and efficiency, (c) prepare and organize LTC resources and concurrently monitor the quality of these resources, and (d) establish a service delivery model that facilitates cooperation among insurers and service providers.