從準市場視角檢視日本長照制度中的公私關係：現況與課題

Public-Private Relationships in Japan’s Long-Term Care Insurance System from a Quasi-Market Perspective: Current Situations and Challenges

日本於2000年實施長照制度，服務的提供幾乎以營利的私部門為主，公部門和非營利組織所占比例有限，形成「以私為主，以公為輔」的服務供給模式。然而，如是的改變能否發揮公私「相互支應」的功能？在公私版圖大移轉的情況下，公私部門之間的關係有何轉變，又產生哪些問題？這些都是本文所欲探究的問題。
研究發現，日本照護服務的供給確實發揮公私相互支應的功能，在政府全國一致的價格管制下，雖然供給主體也有所不同，但因藉由準公共機關來彌補吸脂效應所產生的缺失，故能使基本照護服務勉強取得平衡，現階段服務供給的穩定性尚能得到保障。只不過，最基層的自治體（村）中仍有部分服務項目未能提供，當初所揭示的保障使用者選擇權的政策目標未能全面（國）達成卻也是不爭的事實。因此，隨著公私雙方職能與角色的轉變，扮演宏觀政策管制者的中央政府與微觀政策執行者的基層自治體，以及擔任服務輸送主體的私部門三者之間如何溝通協調，尤其是面對市場條件較差的偏鄉地區，如何避免僅依賴準公共機關，賦予營利與非營利事業經營誘因，以提升整體照顧力並確保照顧服務能穩定供給，則成為公部門日後改革的重要課題。

Japan adopted the long-term care insurance in 2000, with the majority of the services provided by the private sector, and a limited proportion provided by the public sector and non-profit organizations. The services therefore is mainly provided by the private sector and supplemented by the public sector. However, would this change be able to facilitate mutual support among the public and private sector? What kind of relationship change and issues would occur under the public-private transition? These are the questions that would be discussed in this paper.
Study found that the supply of the Japanese long-term care insurance could be mutually supported by the public and private sectors. Under government’s unified price control, although the subject of the supplier is different, quasi public agencies are able to supplement the faults caused by the cream skimming effect. Therefore, striking a balance in providing basic care service and guaranteeing stability in providing services at the current stage. However, there are still some services that could not be provided in primary communities. It is a fact that the objective to guarantee users’right to choose could not be comprehensively accomplished. Hence, with the transformation of the function and role between public and private sectors where central government as macro policy supervisor and local municipalities as micro policy executor, and private third party as service provider, how the three entities communicate and coordinate - especially in facing those rural areas with worse market conditions - how to avoid over relying on public sector and provide business management incentive to profit and none-profit organizations, have become an important task in future public sector reform.