以連帶思想檢視台灣長照政策發展之挑戰與啟發

Challenges with the long-term care policy in Taiwan: application of solidarity

長照政策將會是我國衛生福利政策影響深遠的制度。我國長照政策發展脈絡借鑒OECD國家發展經驗，並以典型社會保險路徑國家如德國與日本為藍圖。面對未來資源有限，長照需求龐大的時代，除透過發展成熟的保險治理技術，如何以衛生與福利政策之連帶思想元素，作為長照政策發展之參考，為本文目的。本文回顧中英文資料庫有關連帶思想概念之歷史發展及運用於長照政策中之當代意涵，結果發現：可由人際間連帶、家庭連帶、世代間連帶、制度性連帶及全球連帶等概念來加以討論。最後，本文就政府、服務提供者及服務使用者等利害關係人(stakeholders)角度，依個人實務工作經驗，提出以連帶思想概念檢視我國長照政策發展可能面臨的挑戰及啟發。

The long-term care policy in Taiwan will have an enormous impact on the health and welfare system. Historical institutionalism and path dependency have served as a blueprint for Taiwan, thus allowing policy makers in Taiwan to learn through the experiences of OECD countries, such as Japan and Germany. Moreover, historical institutionalism and path dependency have shaped the development of the long-term care policy in Taiwan. The purpose of this article was to discuss how to implement a joint concept of solidarity as a health and welfare policy at a time when resources are limited and demand is great. Thus far, the government has been successful in developing insurance management skills, but other means are necessary to implement this new element of solidarity into the current system. This article reviewed the historical development and contemporary implications of solidarity in the English and Chinese databases, and examined how interpersonal, contractual, family, intergenerational, and global factors play a role in the development of solidarity. Finally, we propose the possible challenges and applications of solidarity in the long-term care policy in Taiwan with respect to the views of the government, service providers, and service users.