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長期看護保險商品及消費者購買須知之探討 / The study on long-term care insurance products and shopper's guide林士聘, Lin, Shih Pin Unknown Date (has links)
面對國人的人口老化及老年人慢性疾病逐年升高趨勢,隨著國人生活水準改善,醫療技術提升,平均餘命亦逐年提高;尤其,近年來國人平均餘命上升幅度較往年更為快速,加上少子化現象,對於衍生之老人照護問題,值得政府及民間各界重視。政府近年來大力推動長期照護政策,2007年推動「我國長期照顧十年計畫」,2009年底將「長期照護保險法」草案送立法院審議,預定2011年後實施長期照護保險制度。給付型態以實物給付(服務提供)為主,現金給付為輔,給付水準區分四級,且有補助時數限制。草案中引進「部分負擔」作法,超過政府補助時數,將由民眾全部自行負擔照護費用,可見被照護者或家屬所須負擔之照護費用及精神壓力,仍是一項沈重的負擔。
依據經建會委託長期照護服務需求評估報告及我國長期照護資源供給調查報告,顯示未來長期照護服務需求與照護資源供給相差甚遠。綜觀各國政府所提供之長期照護保障,以基本保障及服務為原則,若要達到讓身心功能障礙者,能夠增進獨立生活能力,提升生活品質,以維持尊嚴與自主之目的,當然,須要靠商業長期看護保險的補充,才能架構完整的長期照護保障網絡。
觀察國內在1995年全民健保制度實施後,明顯激發了民眾對於商業保險之健康醫療保險商品需求的重視與認同。以全民健保制度開辦當年(即1995年)至2004年,此十年間的商業健康保險保費收入來看,十年之間健康險保費收入成長超過七倍。顯示政府推動全民健保制度後,不但激發民眾潛在需求意識,而且促進商業保險商品多元化快速發展。依照先進國家在長期看護保險商品市場的發展經驗,保險公司除重視其商品架構之開發,針對消費者對於長期看護保險的各種認知問題,也應要求業務人員在銷售過程說明清楚,以擴大潛在商機,及避免日後產生非必要之爭議。
有鑑於此,本研究除了詳細彙整介紹德國、日本及台灣政府長期照護制度現況,並對於美國、日本及台灣長期看護保險商品市場進行深入介紹與探討,且對於美國、英國長期看護保險消費者購買須知進行深入介紹與探討。目的在藉由本研究之介紹與探討之結果,提供台灣保險產業長期看護保險之商品開發、業務推動及編製長期看護保險消費者購買須知等實務運作之重要參考。拋磚引玉,期待保險產業有志之士一起掌握藍海商機,協助消費者購買到適合自己的長期看護保險保單。 / Aging population is a topical issue to today’s society, with improved living standard, advanced medical technology, and rising trend of chronic diseases; causing life expectancy to increase year by year. As a result of faster increase in life expectancy in recent years, together with the phenomenon of low birth rates, long-term care is an issue that should be taken seriously to both the public and the government. Recently, the government has been promoting long-term care policy vigorously, where it published “Taiwan’s 10 Years Long-term Care Program” in 2007, submitted “Long-term Care Insurance Law ” draft to the Legislative Yuan of Republic of China by end of 2009, and is scheduled to implement “Long Term Care Insurance” by 2011. Long-term care benefits provided by the government can be classified into four levels, and the benefits will mainly be service based, with hours limit, supported by cash payments. This means that, any long-term care exceeding government’s limit will have to be paid by the user, which may be a stress and burden, financially and mentally, to the family of those needing long-term care.
According to “Long-term Care Service Needs Assessment Report” and “Supply of Long-term Care Resources Survey Report” consigned by the Council for Economic Planning and Development, it can be seen that the supply of long-term care resources can never quite meet the demand of long-term care services. After studying long-term care benefits provided by other governments, it is clear that commercial insurance is essential to allow people requiring long-term care to maintain a full standard of living. This may includes being able to live independently, to improve the quality of life, and to maintain one’s dignity.
By observing the National Health Insurance (NHI) in Taiwan, implemented in 1995, it has stimulate people to be aware of their personal needs towards private health insurance products. The premium of private health insurance products had been increased by seven times from 1995 to 2004. It has been proven that government’s strong support on the NHI has help people to better understand the demands on their health protection, and at the same time, diversify private health insurance products. An overview on the experience of developing private long-term care insurance products in developed countries, insurance companies not only focus their core competence on developing insurance products but also pay attention on maintaining customers’ satisfaction, customer loyalty and customer retention. It is essential that insurance sales agents should help clients choose insurance policies that suit their needs by explaining policies in detail, in order to create new business opportunities and prevent from any future claim conflict or argument.
In view of this, the purpose of this research is to firstly introduce the long-term care system in countries such as German, Japan and Taiwan, study on the experience of developing private long-term care insurance products in developed countries, and follow by an in-depth study and discussion about U.S. and U.K. shopper’s guide to long-term care insurances. Moreover, the findings of this dissertation can hopefully provide suggestions to insurance companies on development of long-term care insurance products and help building consumers satisfaction and consumer retention. To conclude, it is important to create a win-win solution to both customers and insurance companies, where insurers shall develop long-term care products that satisfy customers’ need and in return profit from the market opportunities.
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