外籍看護人力政策：一個臺灣與日本的比較研究

Abstract

臺灣與日本面臨相似的少子女化與高齡化挑戰，長期照顧需求急劇增加，兩國政府均採取引進外籍看護工做為人力資源補充的政策，然而兩國的政策理念與制度設計差異極大。本研究透過比較政策分析法，從基本定位、進用管道、勞務分工、專業技能、權利保障、社會衝擊六個面向，對臺日外籍看護政策進行結構化比較，以深入瞭解兩國長期照顧體系的制度選擇邏輯及其社會影響。 臺灣採取被動式市場化政策，將外籍看護工定位為非技術性、臨時補充的勞動力，由民間仲介機構主導招募與管理，進入門檻低，不提供長期居留權。雖然低薪資與高彈性，可滿足家庭短期照顧需求，但導致照護品質參差不齊、勞工權益缺乏保障、職務邊界模糊、工作風險高。長期而言，政府對本國長照服務體系的投資不足，形成長照雙軌制與政策脆弱性。 日本採取制度化、高標準政策，將外籍看護工視為具有專業技能與人力資本價值的移民，透過經濟夥伴協定（Economic Partnership Agreement, EPA）、技能實習制度（Technical Intern Training Program, TITP）、特定技能制度（Specified Skilled Worker, SSW）等多軌制進用。政府投入高成本的日語與專業訓練，要求通過日本語能力測試與介護福祉士國家考試，確保與日本籍人員同等的勞動保障、社會保險及福利待遇。考取介護福祉士資格者可申請永久居留權，職務分工明確，限於照護機構內進行專業化照護。然而，嚴格的進入門檻與高標準要求限制了人力供給，導致雖有龐大需求卻無法充分引進人力。 兩國政策差異根本上反映了不同的長期照顧體系理念，臺灣將長照視為家庭與市場責任為主、政府補充為輔；日本將長照視為社會保險制度下的公共責任。臺灣的市場化模式短期內紓解了照護人力危機，但長期代價為照護品質風險、勞工權益低弱與長照體系發展遲滯。日本的制度化模式提供了周全的保護與品質保證，但嚴格控制導致人力供給無法充分滿足實際需求。 本研究結論為臺灣應在逐步完善訓練與認證機制、擴大勞動保護、整合長照體系、改善本國人力待遇的基礎上，形成既能回應人力短缺、又能確保照護品質與勞動權益的持續性長照制度。

Taiwan and Japan face similar demographic challenges of low birth rates and aging populations, resulting in a dramatic increase in long-term care (LTC) demands. Both governments have adopted policies to recruit foreign caregiver workforces as a labor force supplement; however, their policy rationales and institutional designs differ substantially. This study employs comparative policy analysis to examine Taiwanese and Japanese worker policies across six analytical dimensions: basic positioning, recruitment channels, task division, professional skills, labor rights protection, and social impacts. The aim is to understand the institutional logic underlying each country's long-term care system and its far-reaching social consequences. Taiwan adopts a passive market-oriented policy that positions foreign care workers as non-technical, temporary supplementary labor managed by private intermediary agencies. Entry barriers are low. foreign caregiver workforces are excluded from the coverage of the Labor Standards Act and are not granted long-term residence rights. While low wages and high flexibility meet short-term household care needs, this approach results in inconsistent care quality, inadequate labor rights protection, blurred job boundaries, and high occupational safety risks. In the long term, insufficient government investment in the national long-term care service system has created a dual-track care system and policy fragility. Japan adopts an institutionalized, high-standard policy that views foreign caregiver workforces as immigrants possessing professional skills and human capital value. Multiple recruitment channels are utilized, including the Economic Partnership Agreement (EPA), Technical Intern Training Program (TITP), and Specified Skilled Worker (SSW) system. The government invests substantially in Japanese language and professional training, requiring successful completion of Japanese Language Proficiency Test and the national Care Worker (Kaigo Fukushi-shi) Certification Exam. This ensures that foreign caregiver workforces receive labor protections, social insurance, and welfare benefits equivalent to Japanese citizens. Those who pass the Care Worker certification exam may apply for permanent residence. Job duties are clearly defined and limited to institutional care settings, emphasizing professionalization. However, strict entry requirements and high standards restrict labor supply, creating a paradox: despite enormous demand, the system cannot recruit sufficient foreign caregiver workforces. The divergent policies fundamentally reflect different conceptualizations of long-term care: Taiwan views LTC primarily as a family and market responsibility with limited government supplementation, whereas Japan regards LTC as a public responsibility under the social insurance system. Taiwan's market-oriented model temporarily alleviates labor shortages but incurs long-term costs in care quality risks, labor rights vulnerability, and underdeveloped LTC infrastructure. Japan's institutionalized model provides comprehensive protection and quality assurance but cannot fully meet actual labor demand due to restrictive controls. This study concludes that Taiwan should establish a sustainable long-term care system that addresses labor shortages while ensuring care quality and labor rights protection. This requires improving training and certification mechanisms, expanding labor law protections, integrating the LTC system, and enhancing compensation for domestic care workers.