德國與臺灣身心障礙者政策與失能者長照政策的比較分析：復健模式的觀點

Comparison of Disability Policy Models and Long-Term Care Policies in Germany and Taiwan: A Rehabilitation-Oriented Perspective

臺灣因人口老化推動長照政策，從「長照十年計畫」、〈長期照顧服務法〉、〈長照保險法草案〉到「長照2.0」都顯示，臺灣長照政策提供給失能者的照顧服務與〈身權法〉的障礙者服務內容相當雷同。採取長照保險來解決老人長照問題的德國，在其「復健取向」障礙政策模式下，區分障礙者與失能者的服務內容及價值。本文採用內容分析法、歷史分析及比較研究法，以M. Maschke 的障礙政策模式為架構，探討德國「復健取向」障礙政策模式對其長照保險中障礙者給付之影響，並比較分析德國與臺灣在障礙政策及長照政策中障礙者服務的差異。研究結果顯示，德國將障礙者服務定位為重返社會與勞動生活的復健服務，具有自決及參與的積極特徵，與失能者多由他人維持日常生活的服務不同。相較之下，臺灣障礙者政策模式及核心價值並不明確，而長照政策也未能區別失能者與障礙者照顧服務之差異，導致臺灣失能者與障礙者在不同的評估標準下，所獲得的服務卻高度相似的結果。

Since 2007, the Taiwanese government has promoted associated long-term care (LTC) policies in response to demographic changes in Taiwan's aging society. According to the most recent draft of the LTC insurance law, the government Taiwan intends to provide LTC services that are almost identical to disability services. By contrast, under the rehabilitation-oriented disability policy model, LTC for elderly people is separate from the disability services in the LTC insurance program pioneered in Germany. Through a content analysis of the relevant disability laws and comparative historical analysis, the framework of Michael Maschke's disability policy model is used in this paper to explore the effect of the German disability policy model on the benefit plan for persons with disabilities, and the differences in cases of LTC insurance between Germany and Taiwan are compared. The results indicate that under Germany's rehabilitation-oriented disability policy, disability services are defined as lifelong support measures for assisting people with disabilities in resuming their work and social life. However, LTC for elderly adults depends entirely on other LTC insurance recipients and is distinct from disability support services. The disability policy in Germany prioritizes rehabilitation over LTC services, and this is because LTC imposes a financial burden on social expenditures. By contrast, the orientation and core values of the disability policy model in Taiwan are unclear, thus affecting the benefits planning of LTC insurance and leading to the absence of differences between LTC services and disability services under two distinct evaluation criteria.