近年來，由於家庭型態急速變遷，受少子女化現象、公共衛生發展、疾病之有效控制，及科技醫療發達等影響，全球人口高齡化現象日益顯著。根據內政部統計統計，我國截至2012年止，老年人口所佔比率，已大幅攀升至11.15%，該現象顯示未來，老年生活之經濟安全保障，已成為國內重大社會課題之一，而政府為了加強老人福利服務、醫療照護與保健等，近幾年來更是積極規劃「長期照護」等相關政策。
在我國，「長期照護」主要係指針對缺乏自我照顧能力者，提供健康與社會照顧之服務，雖然各年齡層人口均有發生長期照顧需要之風險，惟老人係照護服務需求之主要族群；由於照護時間往往漫長且無法預期，其成本往往超出家庭成員可負擔之範圍，普遍認為需由政府積極介入；惟中央財政缺口日深，舉債額度業逼公債法之上限，如何籌措財源即成為首要之務，按政府目前規劃方向，係朝開辦單一制之社會保險因應。
然而，我國已開辦之社會保險種類繁多，根據立法院預算評估報告，勞保、退撫、國民年金保險三大退休保險基金財務缺口總額已逾台幣八兆元，且持續惡化中，如今再將全民強制納入長期照護之被保險對象，是否適當有待商榷，且長期照護保險未來開辦後，若仍維持「高給付、低費率」之設計，恐落入相同財政困境，使負債世代移轉問題日益嚴重，且影響基金永續經營。
況且，如何說服所有民眾願意繳納長達數十年之長照保險費，直至「有可能發生」身心功能障礙，且持續達六個月以上時，始得被列為長期照護服務之對象，獲取保險給付及相關補助等，亦是項艱難的任務；另外，開辦後對於國內經濟將產生之影響與衝擊，更須妥為評估。
本研究將以目前已開辦之社會保險經營現況、國家財政、經濟發展情況及各界觀點等為切入點，佐以他國實施之經驗為參考，並就各種財源籌措方式之優缺點，以及社會民眾之接受度等，討論我國長期照護財源籌措較可行之方式。 / Globally, population aging has become an increasing trend in recent years due to rapid changes in family patterns, low fertility rate, development of public health and effective control of diseases, and advanced medical technology. According to local statistics, as of 2012, Taiwan’s elderly population has substantially increased to 11.15%. This denotes the future economic security of old people which has become one of the major social issues in Taiwan. In recent years, the government has also actively implemented policies relating to “long-term care” in order to strengthen welfare services, nursing and medical care for the elderly.
In Taiwan, “long-term care” means to provide health and social care for dependent-care patients. Old people are the primary focus of care services, although people of all ages are likewise at risk of requiring long-term care. Given the long-term and unexpected time involved in care giving as well as the high expense that families could incur, the government is actively considering a social insurance system. With the increasing gap between the national budget and the debt limit which affects the law governing government bonds, raising funds has become a priority. To establish a unitary social insurance system is the current direction that the government wants to take.
However, Taiwan has already established various forms of social insurance. Based on reports from the legislatures’ budget and assessment, there is a financial gap in three major pension funds including labor protection, civil service pension and national annuity insurance, which has exceeded NTD 8 trillion and is constantly getting worse. Recently, there was an issue whether to require everyone to apply insurance with long-term care. By implementing a long-term care insurance in the future, there would be a constant need to maintain a “high pay, low rate” package that could possibly lead to a similar fiscal difficulty, which would increasingly aggravate the transfer of debt from generation to generation, affecting sustainable operation of the fund.
It is also difficult to persuade people to pay insurance premium for decades until physical and mental problems occur and last for over 6 months. It is only during this period that people can avail long-term care services and receive compensation and subsidy. The effect and impact of introducing this form of insurance on the domestic economy needs to be further evaluated.
With an established social insurance management status, the national budget, the economy and opinions from all members of society as well as experience of other countries should be considered as a starting point or reference in initiating such plans. This study discusses potential measures for long-term fund raising based on the advantages and disadvantages of various fund raising measures as well as social acceptance.
| Identifer | oai:union.ndltd.org:CHENGCHI/G0999210861 |
| Creators | 蘇品心, Su, Pin Hsin |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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