日本將長期照護服務定位為社會福利事業，過去一直以社會福利法人為提供主體。隨著高齡化的進展，長期照護服務的需求日益擴大，該福利法人所能提供的服務量早已不敷使用，以致形成不需住院的老人佔用醫療資源的「社會性入院」弊端。日本政府因此導入介護保險及福利事業民營化，牌便藉營種事業的加入，促進長期照護市場的供需平衡，進而經解醫療保險財政赤字，因此，福利事業民營化的效率備受矚目。但私營企業以營利為目的，在低成本高收益的利潤使下，營稅業提供的服務品質能否維持一定水準，值得關切。其次，營利事業基顧利潤動機所決定的價格與原福利事業所規定的價格必要落差，此落差可能導致資分配的扭曲。基於此，介護保險的服務報酬由中央決定，以期落實保險給付的普遍及公平。同時，為防止民眾的導德風險，保險給付必須透過專業人員的「需照護認定」手續，並設定給付額度。惟照護報酬與需照護認定畢竟由人為決定，因此難免有表面公平而實際不公平之虞。由是，介護保險制度的公平性更受期待。本稿藉由介護保險實施2年半來的成果檢驗，側面凸顯提高福利事業民營化的效率有賴政府政策鬆綁以及適當介入二者配套運用；而介護保險的公平性可望在專人監督（第三者評價）以及民眾同意的前提下，逐步改進。

Long-term care is categorized as a social welfare business in Japan, and social welfare corporation mostly supplies its market. However, with the aging of society, these organizations can no longer provide the need for the expanding market, and lead to unnecessary occupancy of medical resources. Therefore, the Japanese government establishes the long-term care insurance and promotes the Participation of a variety of independent enterprises such as people in private enterprise, agricultural cooperatives and citizens’ non-profit organizations, so to meet the demand of the market and reduce the debts. Hence, the efficiency of system after privatization is brought into spotlight. It is questionable whether private organizations will maintain their quality when they are driven by profit. Besides, private enterprise set their charges by a different standard, which may lead to uneven distribution of resources in the market. Due to those reasons, the government to ensure fairness restricts the rates for long-term care services. Also, municipalities shall provide long-term care requirement certification and support requirement certification based on the screening judgment results of the long-term care approval board. The process is arbitrary and may lead to unfairness. Therefore, the fairness of the long-term care insurance system is also a concern. By examine the results of long-term care system since it was put into practice two and a half years ago (since April1, 2000), this essay states that the complementary performance of proper governmental involvement and easing of official restrictions improves the efficiency of private welfare organizations. Meanwhile, the fairness of the system can be approved under the supervision of professionals (the third party) and agreement of the general public.