日本介護保險輔具給付及支付制度與借鏡

Assistive Devices Payment System with Long-term Care Insurance in Japan: A Reference for Taiwan

過往我國長期照顧的輔具政策僅補助購買，然在2018年起之長期照顧十年計畫2.0中，將給付及支付之輔具（E碼）部分項目採可租賃的模式，為小規模辦理租賃，但衛生福利部將視此新制度的實施經驗，滾動式修正。本文探討已實施近20年之日本介護保險「福祉用具給付與支付」制度，發現日本明確規範「租賃為主、購買為輔」的長照輔具制度，並要求輔具產品須經審核登錄與取得TAIS編碼；給付採依據需支援或介護等級的個人額度制，並有一定比例之自付額；以及利用精心規畫的福祉用具租賃業者的營運指定基準，作為品質確保重要管理機制。日本長照造就一個龐大經濟規模且有服務品質的輔具市場，且能使利用者是謹慎使用長照輔具資源。參考日本長照輔具制度，本文針對我國長照輔具給付及支付，提出相關討論與建議，期作為未來相關單位規劃之參考。

In the past, our national long-term care policy only subsidized the purchase of assistive devices. In the long-term care ten-year plan 2.0 starting from 2018, part of the assistive devices for the payment (E code) will be subsidized for rent. But this payment system for rent is on a small scale. The Ministry of Health and Welfare promise to regard the implementation experience of this new system and will do rolling correction. As a reference for our future development of long-term care services for assistive technology, this paper explores the policy of assistive technology under the Japan long-term care insurance which has been in place near 20 years. It is found that Japan clearly defines their long-term care services for assistive technology as a primary“subsidies for rental services”system with only a few subsidies for purchase, and requires the subsidized assistive devices to be audited and registered with TAIS code. A personal quota system based on the level of support or care required, a certain percentage of the deductible, and use of a well-planned benchmarks for the operation of the assistive devices leasing industry as an important management mechanism for quality assurance are implemented by Japan. Japan’s long-term care insurance creates a large-scale economical and service-quality assistive technology market, and enables users to use the long-term care subsidy resources with caution. Based on the experience of the Japanese long-term care insurance, this paper gives discussion and recommendations for the assistive technology-related polices, plus the payment system, the vendor registration system, and the needs assessment by the qualified assistive technology professionals in our national long-term care 2.0 plan.