從台灣長期照護保險制度實施歷程 探討整合式長期照護模式的可能性

Abstract

人口老化、慢性疾病盛行是世界各主要國家面臨的重大挑戰，台灣更因少子化的家庭結構，使得老年人口照顧問題雪上加霜。台灣自1993年即已邁入高齡化社會（65歲人口大於7%），至2013年老年人口更達11.5%。因應人口快速老化的趨勢下，政府自2008年即開始著手規劃長期照護保險制度，透過2007年開始實施的｢我國長期照護十年計畫｣的先導計畫，期待於民國106年（2017年）開辦台灣長期照護保險制度。 長期照護的涵義並非單純的生活照顧，而是應該包含身心的人性化照顧。長期照護應為一個完整的體系，是一個持續進行、多元而適應個人的照護過程。其目的是使受照護者返回原有生活，持續與社會有所互動，因此世界各國目前的長期照護政策皆走向｢在地老化｣、｢居家及社區式照護體系｣。 本研究從長期照護的定義與世界各國及台灣長期照護的發展歷程開始，並介紹預計實施的台灣長期照護保險制度與相關疑義。本研究比較各種目前長期照護模式不足之處，並提出新型態的照護模式：整合式長期照護模式。 長期照護產業為勞力及資金密集產業，負有社會責任的企業型態，具高風險而穩定長期的低利潤產業。由於現今就業市場人才不易尋找，長期照護產業發展具有一定困難度。整合式長期照護模式以新型態運作方式，結合管理中心、照護管理資訊科技與照護計畫，以解決顧客長期照護產生的照護問題，並符合居家及社區化照顧的型態。 本研究為描述性個案研究，探討新型態之整合式照護模式的可能性，文中以Business Model Canvas及四格式商業模式圖分析整合式照護模式可能的成功因素及運作模式，並做簡單的財務分析以說明獲利來源。 長期照護產業具備產值大而分散的特性。長期照護業者在未來產業競爭環境下需要以群體合作的力量，充實自身管理能力，運用新的技術知識，才能在未來的長期照護市場中持續生存，整合式照護模式或許是可能的方式。

The aging population and the increasing prevalence of chronic diseases are two challenges of major contries in the world. This issue is more complicate in Taiwan because of decreasing birthrate. Taiwan has been a aging society since 1993 ( Aging society means more than 7% people above 65 years old ). The percentage is soon increasing to 11.5% in 2013. The government of Taiwan started to program Long-Term-Care Insurance in 2008 and hoped to introduce in future 2017. The content of Long-Term-Care (LTC) is not simply an issue of life care, but more an issue of humanity. LTC should be a complete system, a process of continuation, a manner of multielement, and a mode of individualization. The purpose of LTC is to help people go back to life, interact with others. Thus the policy of LTC is becoming “Aging in Place” in recent years. Our study discusses about the content and the evolution of LTC, and also the issue of LTC Insurance in Taiwan. It discusses the differences between many kinds of LTC systems. We propose a new business model, a new LTC system － Integrated-Long-Term-Care system. LTC industry needs a lot of labors and capitals, and assumes social responsibility. It has characters of high risk bu shares stable long term low profit. The LTC industry operates difficultly because of many factors. The Integrated LTC system solves these problems with new technologies and care plans. It is in line with the expectation of many current LTC scolars. Our study is a kind of descriptive case study. We discuss about the possibility of implementing Integrated LTC system. We use Bsiness Model Canvas by Alexander Osterwalder to analyse the possible successful factors and the operational models. We also make a simple financial forecast for this business model. The LTC industry is a large but diffused industry. Firms engaged in LTC industry should have cooperational team members, the ability of management, new technological knowledges, in order to survive in the future competitive environment. The Integrated LTC system may be the possible solution of this challenge.