臺灣公共長期照顧制度財源適切性探討：借鏡瑞典經驗

Adequacy of Funding in Taiwan’s Public Long-Term Care System: Lessons from the Swedish Experience

面對著長期照顧經濟需求所具有的長期性及不易在代際間及代際內求得分散的風險屬性，從瑞典公共長照的發展經驗可以看出，以一般稅收作為單一型態源，實無法完全因應長照的經濟風險。支應國內稅收制長照2.0運作財源的「長照服務發展基金」，在2017年到2023年間表現樂觀的基金盈餘背後，卻因主要財源係來自於具機會稅及懲罰稅性質的相關指定用途稅，而暗埋了基金來源在未來可能會出現大幅動盪的隱憂。因之，建議臺灣公共長照在未來的財源規劃上，宜重新思考一般稅收及指定用途稅在主要及輔助角色配置上的適切性，或是將具指定用途稅性質的保險費搭配政府稅收，來做多元且具長期穩定性的長照財源配置。

Because of the long-term nature of care needs and limited potential for risk diversification, Sweden’s experience with developing its public long-term care system demonstrates that relying solely on general tax revenue as a funding source is insufficient to address the economic risks associated with long-term care. Between 2017 and 2023, Taiwan’s Long-Term Care Service Development Fund, which provides financial support for the tax-based Long- Term Care Plan 2.0, demonstrated positive results. However, because its primary funding is derived from earmarked taxes with opportunistic and punitive characteristics, the fund faces a risk of major fluctuations in its future revenue sources. Therefore, Taiwan should reconsider the roles of general tax revenue and earmarked taxes in primary and secondary funding allocations for long-term care. Alternatively, combining insurance premiums with government tax revenue may provide a more diversified and stable long-term funding structure for long-term care.