住宿式長照機構法人化之政策分析-利害關係人之觀點

Abstract

背景：臺灣人口快速老化，為回應高齡社會的長照問題，考量長照需求民眾身體各階段之變化，長照服務提供多元選擇性，機構住宿式服務仍為中、重度長照民眾的剛性照顧需求。住宿式機構之布建參照法律為長期照顧服務法及長期照顧服務機構法人條例，法人化制度對於資源布建的影響，及考量機構建置及營運需要高成本的條件，政府採取公私協力方式導引民間資金挹注，亦影響能否滿足民眾對住宿機構的需求。

目的：瞭解臺灣住宿式長照機構法人化之政策施行後，對住宿式長照機構布建之影響，以及民間單位對於參與住宿式長照機構布建之影響因素，並且提出改善建言。

方法：本研究從政策利害關係人角度，透過質性研究之方式，採立意取樣方式，邀請推行長照法人制度的相關人士及民間單位代表作為受訪之研究對象，設計符合研究目的之訪談大綱，採用半結構式個人深度訪談收集研究資料，並藉由內容分析法進行資料分析。

結果：本研究訪談4位長照政策制定者、6位長照法人及住宿型機構相關單位代表，及5位可能投入長照產業之民間單位代表，共15位。彙整受訪者所提及推動法人化策略的正向意見，包含機構法人化可提升政府管理監督效能、法人化機構具經濟規模、法人化有完備法制面規範，具體可遵循。該政策對於民間單位投入住宿式機構的誘因，包含收入穩定、具投資商機、政府經費補助、發揮企業社會責任。相對的，民間單位投入住宿式機構的困難點為法人法制面的限制，包含董事席次及無法取得控制權、機構收費有上限、機構建置成本高昂、長照人力不足。建議可以開放投入之民間單位以資金雄厚企業為宜，包含保險業、建築業及金融業。

結論：住宿式長照機構法人化政策有助於住宿式長照機構布建、提升監管效能，但其申設程序、必要財產門檻、以及對民間單位參與住宿式長照機構誘因不足，還需要政府部門調整因應，才能達到預期目標。

Background: Taiwan's rapidly aging population has prompted a response to the long-term care challenges of an aging society. Given the varying physical status of individuals requiring long-term care, a range of services are offered. However, institutional residential services remain essential for those with moderate to severe long-term care needs. The establishment of residential institutions is regulated by the Long-Term Care Services Act and the Corporate Regulations for Long-Term Care Service Institutions. The corporatization of these institutions affects resource allocation, the high-cost conditions required for the establishment and operation of institutions, and the government's adoption of public-private partnerships to attract private investment also influence the ability to meet the service needs of the public.

Purpose: To understand the impact of Taiwan's policy implementation of corporatization residential long-term care institutions on their establishment, identify the factors influencing private sector participation in establishing these institutions, and propose improvement suggestions.

Method: This study adopts a qualitative research approach from the perspective of policy stakeholders, utilizing purposive sampling. Relevant individuals involved in promoting the long-term care corporatization system, as well as representatives from private sector units, were invited as research subjects. An interview outline was designed to meet the research objectives, and semi-structured in-depth personal interviews were conducted to collect data. The data were then analyzed using content analysis.

Result: This study interviewed a total of 15 individuals: 4 long-term care policymakers, 6 representatives from long-term care legal entities and related residential institutions, and 5 representatives from private units potentially investing in the long-term care industry. Respondents expressed several positive opinions on promoting the corporatization strategy, including enhanced government management and supervision efficiency, economies of scale for corporatized institutions, and comprehensive legal regulations that can be specifically followed. The policy's incentives for private units to invest in residential institutions included stable income, investment opportunities, government funding subsidies, and fulfillment of corporate social responsibility. Conversely, there were also noted difficulties for private units investing in residential institutions such as legal restrictions on the corporate system (e.g., board seats and the inability to obtain control rights, institutional fee caps), high establishment costs, and insufficient long-term care personnel. It is suggested to open investment to financially strong enterprises, including the insurance, construction, and financial industries.

Conclusion: The corporatization policy of residential long-term care institutions aids in their establishment and enhances regulatory efficiency. However, its application procedures, required property thresholds, and insufficient incentives for private sector participation still need government adjustments to achieve the expected goals.