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引文資料
題名:
從美國經驗探討臺灣長期照護制度改革
書刊名:
臺灣公共衛生雜誌
作者:
傅健豪
/
林翠芳
作者(外文):
Fu, Chien-hao
/
Lin, Tsui-fang
出版日期:
2017
卷期:
36:6
頁次:
頁531-544
主題關鍵詞:
長期照護政策改革
;
居家照護
;
社區照護
;
社區居家照護法案
;
長期照護保險
;
Long-term care policy reform
;
In-home care
;
Community care
;
Community Living Assistance Services and Supports Act
;
The CLASS Act
;
Long-term care insurance
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
3
) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:
3
共同引用:
22
點閱:142
本文探討美國長期照護制度及近年長期照護政策改革方案,期望能借鏡美國經驗,提供我國發展長照政策之參考。綜觀美國近年長照改革,除強化機構服務品質外,並持續發展個人化、家庭化、及社區化的長照服務,鼓勵家庭照顧者成為長照體系的一環,建立在地化的服務輸送體系。美國長照政策改革失敗之主因繫於長照財務,1988年老年醫療保險擴張改革,因保費調漲及稅負分配問題引發反彈,而2010年隨醫改通過的社區居住照護法案,雖欲建立自願投保的公共保險,卻無法確保清償能力下仍能維持可負擔的低廉保費。借鏡美國經驗,我們認為長照2.0以發展居家照護與社區照護為主,政府應重視家庭成員提供失能者無償照顧背後隱含的龐大社會成本,考慮讓家庭成員成為長照產業供給人力,實施現金給付政策並提供完善喘息服務。此外,家庭化及社區化的長照服務可能易因地區收入間的差異,而導致服務品質落差。未來政策應強化照顧者專業能力,及確保照護品質的地域平等性。最後,待長照服務體系建置完善及照顧人力充足後,實施具互助精神且財源相對穩定之長期照護保險是政府可以思考的選項。參考美國改革之例,若日後實施長照社會保險,為避免嚴重之逆選擇問題,建議採強制納保,以維持保險制度之永續經營。
以文找文
The main purpose of this paper is to investigate the long-term care system and recent long-term care policy reforms in the United States (U.S.). Overall, recent policy reforms in the U.S. have focused on improving the quality of institutional care while pushing for more development in personalized in-home and community care. Previous attempts at major reforms in long-term care failed mostly because of issues in financing them. In 1988, the expansion of Medicare and Medicaid coverage and eligibility were quickly overturned due to concerns about rising costs and unequal contributions from taxpayers. Recently, the Community Living Assistance Services and Supports Act (The CLASS Act) was enacted as part of the Patient Protection and Affordable Care Act. The CLASS Act would have established a voluntary national public insurance program for long-term care, but its design prevented the Act from satisfying the requirement to be actuarially sound while keeping the insurance premiums affordable. Learning from the U.S. experience, we suggest that the government should take into account the social costs associated with uncompensated care provided by family members. The government may consider using a cash payment policy and strengthening respite care programs. It is also worth noting that the quality of in-home care and community care might not be equal in different areas. Equipping caregivers with professional knowledge and ensuring the equality of services across regions are therefore critical in designing a successful service-delivery system. Finally, if the government plans to implement long-term care insurance in the future, then, in order to ensure its financial sustainability, a compulsory insurance scheme is needed to avoid adverse selection.
以文找文
期刊論文
1.
梁亞文、劉立凡、林育秀(20101200)。英日兩國長期照護制度對推動我國長期照護制度之意涵。長期照護雜誌,14(3),311-324。
延伸查詢
2.
Finkelstein, Amy、McGarry, Kathleen(2006)。Multiple dimensions of private information: Evidence from the long-term care insurance market。American Economic Review,96(4),938-958。
3.
陳正芬(20060600)。The Long-Term Care Policies in Germany, Japan and Canada: A Lesson for Taiwan。臺灣社會福利學刊,5(1),49-69。
4.
王品(20150300)。德國長期照顧保險效應分析:1995~2013。人文及社會科學集刊,27(1),135-203。
延伸查詢
5.
Etter, S. L.(1995)。The Impact of 'Parent Care' on Female Labor Supply Decisions。Demography,32(1),63-80。
6.
吳肖琪(20170400)。我國長照政策之新契機。長期照護雜誌,21(1),1-7。
延伸查詢
7.
Brown, Jeffrey R.、Finkelstein, Amy(2007)。Why is the market for long-term care insurance so small?。Journal of Public Economics,91(10),1967-1991。
8.
黎佳伶、林藍萍、徐尚為、林金定(20160600)。老年人使用長期照顧服務之需求與困境初探:文獻回顧分析。臺灣老人保健學刊,12(1),48-57。
延伸查詢
9.
施姵宇、古鯉榕、白明奇、劉立凡(20170800)。失智症家庭使用長期照顧服務的情形與不使用的原因。臺灣公共衛生雜誌,36(4),375-385。
延伸查詢
10.
Spillman, B. C.、Pezzin, L. E.(2000)。Potential and active family caregivers: changing networks and the 'sandwich generation'。Milbank Q.,78,347-374。
11.
Bassett, W. F.(2007)。Medicaid's nursing home coverage and asset transfers。Publ. Finance Rev.,35,414-439。
12.
Brown, J. R.、Finkelstein, A.(2008)。The interaction of public and private insurance: Medicaid and the long-term care insurance market。American Economic Review,98(3),1083-1102。
13.
Nadash, P.、Miller, E. A.(2015)。Four pillars of aging policy in the United States。EXLIBRIS Biblioteka Gerontologii Społecznej,2,53-70。
14.
Harrington, C.、Ng, T.、LaPlante, M.、Kaye, H. S.(2012)。Medicaid home-and community-based services: impact of the affordable care act。J. Aging Soc. Policy,24,169-187。
15.
Laliberte, L.、Mor, V.、Berg, K.、Intrator, O.、Calore, K.、Hiris, J.(1997)。Impact of the Medicare Catastrophic Coverage Act on nursing homes。Milbank Q.,75,203-233。
16.
Morreale, J. C.(1991)。The Medicare Catastrophic Coverage Act of 1988: issues of equity in a policy reversal。J. Contemp. Health Law Pol.,7,117-155。
17.
Wiener, J. M.、Estes, C. L.、Goldenson, S. M.、Goldberg, S. C.(2001)。What happened to long-term care in the health reform debate of 1993-1994? Lessons for the future。Milbank Q.,79,207-252。
18.
Miller, E. A.(2011)。Flying beneath the radar of health reform: the Community Living Assistance Services and Supports (CLASS) Act。Gerontologist,51(2),145-155。
19.
Dawson, W. D.(2010)。The CLASS Act and long-term care policy reform: a perspective。Publ. Pol. Aging Rep.,20,16-20。
20.
吳淑瓊(20051200)。人口老化與長期照護政策。國家政策季刊,4(4),5-24。
延伸查詢
21.
Wolf, D. A.(1999)。The family as provider of long-term care: efficiency, equity, and externalities。Journal of Aging and Health,11(3),360-382。
圖書
1.
Cohen, M. A.、Kaur, R.、Darnell, B.(2013)。Exiting the Market: Understanding the Factors Behind Carriers' Decision to Leave the Long-Term Care Insurance Market。Washington, DC:Assistant Secretary for Planning and Evaluation; Office of Disability, Aging and Long-Term Care Policy, U.S. Department of Health and Human Services。
2.
Power, A.(2012)。Landscapes of Care: Comparative Perspectives on Family Caregiving。London:Ashgate Publishing。
3.
National Commission on Fiscal Responsibility and Reform(2010)。The Moment of Truth: Report of the National Commission on Fiscal Responsibility and Reform。Washington, DC:National Commission on Fiscal Responsibility and Reform。
4.
詹火生、林青璇(2002)。老人長期照護政策--國家干預觀點之分析。臺北:財團法人國家政策研究基金會。
延伸查詢
單篇論文
1.
謝明瑞,周信佑(20160613)。長照保險制與長照稅收制之比較分析,http://www.npf.org.tw/2/15908。
延伸查詢
其他
1.
國家發展委員會。中華民國人口推估(105年至150年),https://www.ndc.gov.tw/Content_List.aspx?n=84223C65B6F94D72。
延伸查詢
2.
吳靜君(20170214)。長照險推不動,去年僅4.5萬件,https://udn.com/news/story/7239/2282945。
延伸查詢
3.
Center on Budget and Policy Priorities。Policy basics: where do our federal tax dollars go?,http://www.cbpp.org/research/federal-budget/policybasics-where-do-our-federal-tax-dollars-go。
4.
Harriet, K.。Medicare does not pay for long-term care,http://blog.aarp.org/2013/08/22/medicare-does-not-pay-for-long-term-care/。
5.
O'Shaughnessy, C. V.(2012)。National spending for longterm services and supports (LTSS),http://www.nhpf.org/library/the-basics/Basics_LTSS_03-27-14.pdf。
6.
Freundlich, N.。Long-term care: what are the issues?,https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf410654。
7.
Wiener, J. M.,Khatutsky, G.,Greene, A. M.,Thach, T.,Allaire, B.,Brown, D.。Long-term care awareness and planning: what do americans want?,https://aspe.hhs.gov/system/files/pdf/111341/Awareness.pdf。
8.
National Alliance for Caregiving。Caregiving in the U. S.,http://www.caregiving.org/wpcontent/uploads/2015/05/2015_CaregivingintheUS_Final-Report-June-4_WEB.pdf。
9.
Reinhard, S. C.,Feinberg, L. F.,Choula, R.,Houser, A.。Valuing the Invaluable: 2015 Update, Undeniable Progress but big Gaps Remain,https://www.aarp.org/content/dam/aarp/ppi/2015/valuingthe-invaluable-2015-update-new.pdf。
10.
Van Houtven, C.,Skira, M.,Coe, N. B.。Effect of informal care on work, wages, and wealth,http://crr.bc.edu/working-papers/effect-of-informal-care-on-work-wages-and-wealth/。
11.
Wiener, J. M.,Anderson, W.,Khatutsky, G.,Kaganova, Y.,O'Keeffe, J.。Medicaid spend down: new estimates and implications for Long-Term Services and Supports financing reform,http://www.thescanfoundation.org/sites/default/files/rti_medicaidspend-down_3-20-13.pdf。
12.
Ng, T.,Harrington, C.,Musumeci, M.,Reaves, E. L.(2012)。Medicaid home and community-based services programs: 2012 data update,http://files.kff.org/attachment/report-medicaid-home-andcommunity-based-services-programs-2012-dataupdate。
13.
Eiken, S.,Sredl, K.,Burwell, B.,Woodward, R.。Medicaid expenditures for long-term services and supports (LTSS) in FY 2015,https://www.medicaid.gov/medicaid/ltss/downloads/reportsand-evaluations/ltssexpendituresffy2015final.pdf。
14.
Kaiser Family Foundation。Health care reform and the CLASS Act,http://kff.org/health-costs/issue-brief/health-care-reform-and-the-class-act/。
15.
Haberkorn, J.。Plan HAILED by Kennedy could snag health bill; Budget hawks oppose disability insurance,https://www.washingtontimes.com/。
16.
U. S. Department of Health and Human Service。A report on the actuarial, marketing, and legal analyses of the CLASS program,https://aspe.hhs.gov/pdf-report/report-actuarial-marketing-and-legalanalyses-class-program。
17.
Greenlee, K.。Memorandum on the CLASS program to Secretary Sebelius,https://aspe.hhs.gov/pdf-document/memorandum-class-program。
18.
American Academy of Actuaries。Re: actuarial issues and policy implications of a Federal Long-Term Care Insurance Program,https://www.actuary.org/pdf/health/class_july09.pdf。
19.
U. S. Senate。Commission on Long-Term Care,https://www.gpo.gov/fdsys/pkg/GPOLTCCOMMISSION/pdf/GPO-LTCCOMMISSION.pdf。
圖書論文
1.
Norton, Edward C.(2000)。Long-Term Care。Handbook of Health Economic。Elsevier Science。
2.
Institute of Medicine (US) Committee on Nursing Home Regulation(1986)。History of federal nursing home regulation。Improving the Quality of Care in Nursing Homes。Washington, DC:National Academies Press。
3.
Beshears, J.、Choi, J. J.、Laibson, D.、Madrian, B. C.(2009)。The importance of default options for retirement saving outcomes: evidence from the United States。Social Security Policy in a Changing Environment。Chicago, IL:University of Chicago Press。
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