福利國家的重構：以德國長期照護保險制度的建置與改革為例兼論台灣可得之借鏡

Welfare State Restructuring: Construction and Reform of Long-Term Care Insurance in Germany and Policy Implications for Taiwan

長期照護發展為福利國家核心制度之一是非常晚近的事情。研究者認為，在新、舊社會風險共同出現與後工業社會經濟成長遲緩的條件下，成熟之民主福利國家雖然普遍面對財政緊縮的限制，但透過福利制度的重新結構具有因應環境變遷的創新性能力，而制度重新結構的形式與內涵主要受到福利體制所影響。本研究將分析德國長期照護保險制度的建置與2008年首次重大改革的核心內容、制度運作之成就、缺陷與挑戰。作為保守型福利體制的典型代表國家，本研究透過探討俾斯麥福利國家的核心制度特徵，以及該制度特徵在晚近新社會風險出現所面臨之危機，呈現俾斯麥福利國家如何在人口老化使得照護需求量與質的增加，伴隨著家庭與就業結構轉變導致之照護者可得性降低的情況下，透過照護政策的發展進行福利體系的現代化，並指陳因此衍生的問題。當台灣透過1990年代以來福利體系擴張，建立以俾斯麥模式為主的福利體系，德國的經驗對於台灣在規劃與實施長期照護保險制度上具有實質參考的意義。

It has only quite recently been recognized that long-term care constitutes a core institution of modern welfare states. The author argues that while most of the mature welfare democracies are faced with fiscal restrictions, they do have adaptive ability to modernize themselves with system restructuring that is dominantly conditioned by the welfare regimes. This paper elaborates the construction of the long-term care insurance in Germany – a typical conservative welfare regime – and its major reform in 2008 with the illustration of core institutional contents, the analysis of achievements, shortcomings, and future challenges. With the demonstration of main characteristics of Bismarckian welfare systems and their potential crises resulting from the new social risks, this paper explores how the Bismarckian welfare state processes the system modernization with the development of mandatory social long-term care insurance when faced with the problems characterized by the fact that the ageing population increases the quality and quantity of care, but the transformation of family and employment structure decreases the possibility of informal care. Taiwan has built a newly emerging Bismarckian welfare state through the social policy expansion since the 1990s and is facing similar problems resulting from the new social risks; hence, lessons learnt from the development of the long-term care insurance in Germany will be especially important to Taiwan for system design and policy implementation.