以日本居家照護推動模式檢視臺灣長期保險開辦初期之因應策略與規劃

The Initial Plans and Policies for Long-term Care Insurance in Taiwan-From the Respect of Service in Home Care in Japan

隨著少子化、高齡化社會的來臨，國民醫藥費用的負擔愈加沉重，最近，全民健康保險費的調漲與否一直是一個倍受爭議的話題。此外，台灣也即將開辦長期照護保險。本文檢視10年前即開辦長照保險的日本，以「在地老化」理念實施長照保險給付，由於受到保險財務的限制，無法讓每個納保者得到公平的照護服務，於是日本官方便大力提倡去除機構式服務，改為「居家照護」服務。而在家中接受照護的民眾除了可以使用隸屬長照保險給付的「正式服務」（Formal Service）項目之外，也可以運用自家附近社區廣大的資源及人脈，在此統稱為「非正式服務」（Informal Service）。日本並呼籲各個地方政府，要致力於凝聚社區居民的情感及向心力，才能得到較多的資源來運用。本文藉由他國的經驗，期待台灣在長照保險規劃之初，必須注意到台灣特有的時代及人文背景，以圖將來在實施長照保險時，能以最有效率的方式運用長照相關資源，免除許多摸索的時間與成本，提供國民最大的福祉。With the decline in the birth rate and aging among our population, the medical cost has increased dramatically in Taiwan recently. This makes us focus on whether the health insurance premium should be increased. Following Japan, Taiwan will practice the long-term care insurance in the near future. This paper provides the experience of 10 year long-term care insurance in Japan and how to make the 'Aging in place' work effectively. To ensure that everyone can get the fair service, the Japanese government suggests 'de-facility' policy and charges low cost 'Home care service.' There are two kinds of services available: Formal and Informal Services. Moreover, the Japanese central government also asks local governments to pay attention to the local communities' voices. By taking a look from what was done in Japan, this paper could offer some foundations for the Taiwanese government about how to save cost in long-term care insurance plans and policies.