日本長照保險制度中長照需要評估程序之法律分析

The Legal Analysis for the Need-assessment Process in Japan Long-term Care Insurance Law

面對日益升高之高齡者長照服務需求，日本早於一九九七年制定長照保險法〈原語為「介護保險法」〉作為其二十一世紀社會福利基礎構造改革的序幕；其自二○○○年四月起實施長照保險制度，迄今已有十餘年。同法係兼採取需照護認定或需支援認定（兩者稱之為「需照護認定等」）以及長照服務利用契約（簡稱為「長照契約」）兩法形式，來具體形成長照服務利用的法律關係。特別是前者之需照顧認定，係由保險人即市町村依法作成之判斷行為，主要用來確認提出申請被保險人是否符合法定長照保險給付受領資格以及其保險給付內容之上限。而針對上述需照護認定之申請程序、受理及審定機關之組成、二階段認定程序之建制等長照需要評估程序之具體法制化，正是日本現行長照保險法的法制特色之一。是以，本文將扼要說明日本介護保險法制定後所帶來的社會福利服務提供制度的變革，剖析日本現行長照保險法制之特徵後，將主要聚焦於同法所定長照需要評估程序之具體分析及其法律意義之檢討，期以他山之石，提供作為我國持續推動長照服務法制之參考或進一步深化相關法學研究之基礎。

The Long-term Care Insurance Law (LtCIL) in Japan that created in 1997 was the beginning structure for the Japan's social welfare revolution in 21 century. Since April 2000 the long-term care insurance has been enforced over a decade. According to LtCIL, the users have to go through the following procedures to get the long term care service, First, it has to decide the qualification of applicants by the standardization of the need-assessment process for long-term care. Secondly, what the long-term care service could the user get is depended on the contract negotiation which is between service provider and user. The contract could not be paid over the maximum payment by the law. Both of the procedures have been standardized and they become one of characteristics of LtCIL. There are more detailed rules for the recognized process for the need-assessment. The need-assessment process for applying the long-term care that includes the authorized organizations to submit, to process and to confirm, respectively. According to LtCIL there is required 2 stages to determine the eligibility and the level of need for long-term care and the decision for the need-assessment has limited coverage for the insured payment. This article will illustrate concisely the system's revolution after LtCIL has been established. After stated the whole picture of the current law system, the focus will be on standardization of the needassessment process for long-term care. Hopefully, not only could this article provide our country to practice future long-term care service system but also as a reference for continuous research.