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.

由於人口轉型的影響，導致從高出生率、高死亡率，變成高出生率、低死亡率，進而變至低出生率、低死亡率的結果，預計世界各國將都面臨人口老化的危機，老年人在比例以及數量上都較以往增加，造成傳統日額型或定額型給付無法滿足長期看護的需求，加上社會大眾對於保險的需求與認知的加強，較複雜的保險商品孕育而生。 由於保險商品的多樣化，傳統的精算方法面對考驗，為同時考量利率的波動風險，本研究以隨機過程中的馬可夫鏈理論應用於保險商品的定價、盈餘計算及利潤分析。主要討論下列研究議題：長期看護保單之需求及現況; 不同類型的長期看護保單之計價分析; 利用Visual Basic程式設計長期看護評價系統。 由於長期看護保險的開發不長，因此在相關的統計數據不足。本研究對於長期看護保險看護發生的移轉力，皆參考國外失能保險的經驗加以修正以計算費率，採用隨機過程中馬可夫鏈的觀念，依據被保險人的健康狀態，並根據不同的狀態給予不同比例的看護年金金額，於不同的保險契約型態下探討四種類型的長期看護保險。 第一章 緒論………………………………………………...1 第一節 研究動機與研究目的…………………………………………………1 第二節 研究方法………………………………………………………………3 第三節 研究架構及研究內容…………………………………………………4 第二章 長期看護的需求與供給…………………………...7 第一節 人口學上的發展………………………………………………………7 第二節 醫療及公共衛生改善等因素的影響………………………………..16 第三節 社會學因素的影響…………………………………………………..19 第四節 各國長期看護保險概況……………………………………………..25 第三章 長期看護保險保單……………………………….32 第一節 看護需求的衡量----日常活動量表的探討………………………….32 第二節 長期看護保險的保單條款…………………………………………..43 第三節 各國長期看護保險的保障內容比較………………………………..47 第四章 長期看護保險的精算分析……………………….55 第一節 多階段保險型態的簡介……………………………………………..56 第二節 多階段模型的精算函數……………………………………………..66 第三節 資產額份……………………………………………………………..76 第四節 資產額份的精算分析………………………………………………..78 第五章 模擬分析…………………………………………89 第一節 長期看護綜合系統…………………………………………………..89 第二節 長期看護保險保費計算之模擬……………………………………..90 第三節 長期看護保險資產額份之模擬……………………………………106 第六章 結論與建議……………………………………...114 第一節 結論…………………………………………………………………114 第二節 建議…………………………………………………………………115 參考文獻………………………………………………….117 表目錄 表2-1-1 OECD 會員國人口統計概況表………………………………………… 表2-1-2 65歲以上人口占率與人口高齡化速度的國際比較.……………… 10 表2-1-3 臺灣地區1950年至2035年人口自然成長、三階段人口數及依賴 比……………………………………………………………………… 11 表2-1-4 各國依賴人口比例之比較…………………………………………… 16 表2-2-1 民國55年至85年十大死因死亡率………………………………… 17 表2-2-2 臺灣地區老年人口之患病情形……………………………………… 18 表2-3-1 民國六十五年至八十五年臺灣地區戶數及戶量的變化…………… 20 表2-3-2 民國六十五年至八十五年臺灣地區育齡婦女生育的子女數及胎次 別……………………………………………………………………… 21 表2-3-3 臺灣地區民國六十五年至八十五年總生育率之變化按妻之教育程 度分及大專與國中程度總生育率之比……………………………… 22 表2-3-4 臺灣地區民國五十五年至八十五年15歲以上人口與勞動力人數及 參與率按性別區分…………………………………………………… 23 表3-1-1 機能損失指標內容之比較…………………………………………… 34 表3-1-2 機能損失指標品質之比較…………………………………………… 34 表5-2-1 長期看護年金主約----不同的投保年齡之給付現值與不同的繳費 方式之應繳保費……………………………………………………… 97 表5-2-2 長期看護加強型年金----不同投保年齡之躉繳保費……………… 99 表5-2-3 長期看護年金附約----不同的投保年齡之給付現值與不同的繳費 方式之應繳保費…………………………………………………… 102 表5-2-4 長期看護加強型退休金----不同的投保年齡之給付現值與不同的 繳費方式之應繳保費……………………………………………… 105 表5-3-1 二十年期長期看護加強型年金各保單年度狀態之間移轉機率表 ……………………………………………………………………….. 107 表5-3-2 二十年期長期看護加強型年金各保單年度各狀態的預估人數表 ……………………………………………………………………….. 108 表5-3-3 二十年期長期看護加強型年金資產額份分析表………………….. 111 圖目錄 圖1-3-1 研究架構及研究流程………………...……………………………..5 圖2-1-1 臺灣地區民國40年至125年人口變動率(中推計)………………12 圖2-1-2 臺灣地區民國40年至125年四種人口依賴比(中推計)…………13 圖2-1-3 臺灣地區民國40年至125年的三種人口老化指標 …………… 14 圖4-1-1 存活模型………………………………………………..………….57 圖4-1-2 疾病—死亡或失能模型……………………………..…………….58 圖4-1-3 連生年金模型………………………..…………………………….60 圖4-1-4 CCRC模型個別住戶狀態移轉狀態圖…………………..……….62 圖4-1-5 三個看護等級之長期看護保險個人狀態移轉圖………………...63 圖4-1-6 AIDS發病過程之狀態移轉圖………….………………………...65 圖5-2-1 三個看護等級之長期看護保險狀態及給付比例圖….………….91 圖5-2-2 二階段長期看護年金給付狀態圖……………….……………….97 圖5-2-3 三階段長期看護年金附約給付狀態圖……………….………...100 圖5-2-4 二階段長期看護加強型退休金給付狀態圖…………….………103 圖5-2-5 長期看護加強型退休金給付情況圖…………………….…...….104 / The goal of this study is to investigate the pricing and valuation for the long-term care insurance policies. Three major stages in achieving our objectives are summa-rized as follows: 1. Review the trend of the long-term care insurance and recognize its development. 2. Apply the Markov chain framework and the asset shares methodology to multi-states insurance policies. 3. Construct a comprehensive valuation computer system for profit monitoring pur-pose. Different health statuses of the policyholders are characterized using a Markov chain framework over the contract period. Benefit payments are provided to the in-sured according to his health condition once he is eligible for compensation. Premi-ums for four types of long-term care policies are examined according to the given ac-tuarial assumptions. Since the long-term care policies are still under development, the corresponding experience is not completely known. Hence the experience of the Danish company’s disability insurance are employed in computing the force of transitions. The forces of transitions are then used to estimate the transition probabilities. Finally premiums and reserves can be calculated based on the specified policy. Profit monitoring is also performed through asset share methodology. A numerical illustration provides some interesting results obtained by using this approach.