社會性長期照護保險的財務處理

Financing Arrangements of Long-Term Care Insurance in Taiwan

台灣社會保險給付涵蓋老年、身心障礙、健康、失業等，以及目前正在規劃的長期照護保險。然而，人口老化的速度卻衝擊這些回應社會風險的社會保險財務，永續經營成為社會保險改革與規劃的首要重點。費用掌握、財源籌措以及費率能否順利調整，是財務永續的關鍵因素，其中財務處理方式攸關費率水準的規劃，是財務規劃的重要關鍵部分。社會保險的財務處理方式主要有：完全儲備制（fully funded或稱基金制）、隨收隨付制（pay-as-you-go或稱完全賦課制）、部分提存準備（partial funding），各有其立論精神與優缺點，本研究首先討論社會性長期照護保險的財務處理方式，其次介紹德國及日本長期照護保險費用的調整；最後擬從1.財務永續性（financial sustainability）、2.可負擔性（affordability）、3.世代公平性（intergenerational equity）、4.費率調整的政治可行性（political feasibility）、5.基金規模（the optimal scale of funds）等面向，討論台灣長期照護保險的財務處理方式。

Social insurance benefits in Taiwan include old-age, disability, medical, unemployment, and long-term care insurance, the latter still in the planning stage. However, Taiwan's aging population is challenging the financial soundness of the social insurance systems, which makes sustainable operations the top priority of social insurance reform. Control of expenses, revenue collection and adjustment of the premium rate are the key factors for financial sustainability. Among these, the funding method is critical for premium planning, and it is an important part of overall financial planning. There are three social insurance funding methods: full funding, payas-you-go funding and partial funding. Every method has its perspective, advantages and shortcomings. We discuss the funding methods for long-term care insurance, and review Germany and Japan's experiences with premium adjustments. The last section focuses on the funding methods for long-term care insurance in Taiwan, which the authors evaluate from the following perspectives: 1. financial sustainability, 2. affordability, 3. intergenerational equity, 4. political feasibility of premium adjustments, and 5. the optimal scale for measuring fund amounts.