社會福利民營化與市場化：以日本介護保險制度為例

Privatization and Marketization of Social Welfare: The Case of Japan's LongTerm Care Insurance System

1990年代中期以後，國營事業民營化風潮暫告一段落，隨著人口高齡化的進展與高齡福利需求的擴大，各界對於社會福利民營化、營利福利服務可能性的關注與討論逐漸升高。民營化支持論者多從經濟效率出發，認為可以形成競爭和降低成本，但社會福利是以需要特別保護及社會支援者為對象，屬於公共性強的服務，能否交由自由市場機制，放任民間業者來提供？如參考同為亞洲國家，但積極推動長期照護的日本經驗得知，邁入21世紀，該國透過介護保險制度改革，充分運用民間活力擴大服務供給，開放私部門加入照護服務市場，故照護服務轉換為自由市場主義的服務提供體系－亦即強調競爭與選擇，使用者與供給者對等的「契約制」得以藉由介護保險制度而被落實。然而，該制度施行的結果是否真如理論所言達到預期之目的？在考量福利服務的特殊性所導入的「準市場」概念是否能產生競爭，提供優質服務，以及讓使用者發揮自由選擇權？這些都是本研究所欲探討的課題。作者期望透過本研究累積相關理論與實務經驗，以作為今後我國推動長期照護政策時之參考與借鏡。

The privatization of state-owned business came to an end after the mid1990s. With the growth of an aging society and the need for aging welfare, there has been discussion on the possibility of providing privatized social welfare and for-profit welfare services. Supporters of privatization take the economic efficiency perspective, and believe that this would lead to competition and reduce costs. However, social welfare targets those that require special protection and social support. Therefore, can public services such as social welfare be provided by a free-market mechanism? We take Japan's long term care experience as an example. An Asian country, Japan used civil society to expand welfare service provision via reform of its long-term care insurance system and allowed the private sector to invest in the long-term care market. Therefore, long- term care was transformed into a free-market service system which emphasized competition and choice. The Japanese long-term care insurance system is therefore implemented via a contract between users and providers. However, can such a system be as effective as theory suggests? Can a quasi-market mechanism provide high quality service and allow users the freedom to choose? These are the issues that this research seeks to discuss. The author hopes to accumulate theoretical and empirical experiences via this research, and to provide policy suggestions to the nation's long-term care policy.