德、荷長期照護保險之比較

A Comparison of Long-Term Care Insurance in Germany and the Netherlands

本文介紹德、荷的長照保險制度相關法令理念／政策發展、組織體制、保險對象、給付方式、服務項目、服務輸送體系，及財務機制，以作為台灣推動長照保險之參考。於比較德、荷推動長期照護保險經驗後，提出下列建議，包括：以多元方式籌措財源；財源結構以保險費、稅收、政府補助為主；兼顧風險分攤與社會福利的公平性；設定部分負擔，防止資源濫用；審慎訂定各項服務的給付上限，並以量入為出方式進行財務控管；支付制度的設計應對服務提供者提供服務及提升服務品質具有誘因；長照保險一次到位，將納保對象普及至全民；保費的分攤應兼顧各利害關係人及公平性；設置高可近性的服務輸送體系，並應用適合國人需求經統一評估標準的評估工具分類照護需求程度；透過專責單位整合社政、衛政、退輔及急性醫療、亞急性醫療與慢性醫療。

This paper reports on results of a comparative study of the long-term care systems and relevant laws in Germany and the Netherlands. Information and data used was obtained through articles in the literature. The character of long-term care systems and the major elements of such in both countries are described in detail, including system development, organizational structures, insurance coverage, payment systems, services, delivery systems, and financial mechanisms. Findings-based recommendations are then offered related to Taiwan’s long-term care and emerging long-term care insurance systems. Based on the long-term care insurance implementation experiences of these two nations, the authors propose several policy recommendations, including the following: Premiums, taxes, and government subsidies should provide the major sources of funding for the system in order to minimize risk and achieve equity in service. Co-payments should apply to all provided services in order to reduce abuse of the system. Various financial control mechanisms, including controlling benefit levels and ceilings and applying appropriate care management and financial adjustment mechanisms, are also suggested. As national insurance benefits all insured individuals, premium sharing must consider the equity of relevant stakeholders. Developed service delivery systems should be both highly accessible and use a unified evaluation tool to define the needs of the insured. In addition, the long-term care administration organization should coordinate all current long-term care related services.