台灣長期照護保險制度與日本介護保險執行改革方針

Taiwan Long-Term Care Insurance and the Evolution of Long-Term Care in Japan

我國老年人口至2008年已超過10%，人口老化持續進展，相對造成失智、失能須照護人口數增加。日本於2000年因高齡化社會的進展，長期照護服務需求增加，但福利法人所提供的服務不敷使用，以致於形成不需住院的老人佔用醫療資源，因此於當年4月開始施行介護保險制度，運用市、町、村地方政府提供在地老化之照護，透過福利機構協助，減少財政赤字，並促進長期照護市場供需平衡。在國內長期照護十年計畫中發現，各縣市長期照護管理中心執行力不一，縣市資源落差大，服務提供單位不足，均影響服務使用之意願。故於2009年8月參訪民風習俗較為相近之日本介護保險機構，本文將日本介護保險執行之現況及改革重點，加以整理，內容值得做為台灣發展長期照護保險制度之參考。

The proportion of elderly (65 years of age and older) in Taiwan has exceeded 10% since 2008. With more elderly, the number of patients suffering from dementia and disabilities has also been rapidly increasing. Japan also has been facing increasing demand for long-term care due to an aging society. Prior to 2000, social welfare programs in Japan, working to cope with changing needs, typically provided insufficient services, and geriatric patients were hospitalized unnecessarily, wasting medical resources and causing undue patient hardship. In response, Japan launched its long-term care insurance program in April 2000. Under the program, city, town and village-based organizations should take responsibility for providing care to the elderly in their place of residence. The program significantly improved previous financial shortfalls and long-term care supply and demand has been met by existing social welfare organization resources. In Taiwan, the provision of long-term care by county / city authorities has proven inconsistent, with performance deemed poor after its first decade of long-term care operations. Service was found to be affected by differences in available resources and insufficient long-term care administration. The cultures of Taiwan and Japan are similar. The authors visited the Japan Long-Term Care Insurance Institute in August 2009. Main issues involved in the implementation and evolution of the Japan long-term Care Insurance are reported on in this paper. We hope such may be useful information to those working to develop long-term care programs in Taiwan.