長照2.0服務遞送的設計：從交易成本與代理成本觀點評析

On the Design of Long-Term Care 2.0 Service Delivery: Perspectives from Transaction Cost and Agency Cost

10.6635/cpar.201909_25(3).0004

簡鈺珒(Yu-Chin Chien)；呂季蓉(Chi-Jung Lu)

長照2.0 ； 公私協力 ； 代理理論 ； 道德危險 ； 資訊不對稱 ； 隱藏資訊 ； long-term care 2.0 ； public-private partnership ； principle-agent theory ； moral hazard ； information asymmetry ； hidden information

中國行政評論

25卷3期（2019 / 09 / 01）

97 - 122

繁體中文

在「在地老化」的理想下，政府於106年推動長期照顧十年計畫2.0正式上路，希望建構「找得到、看得到、用得到、付得起」系統，結合中央政府、地方政府、公益性團體和基層社區組織，佈建完善的「社會安全網」。取代過去單純由政府提供服務的思維，透過公私協力的方式共同提供長照服務，來彌補「層級治理」之不足，然而這種公部門委託民間團體組織代理長照服務遞送的協力關係，卻又可能產生委託－代理的問題，包括如何避免委託人與代理人之間的資訊不對稱，或是降低因隱藏行動和隱藏資訊而使長照服務品質參差不齊的情形，都有必要從長照服務遞送的流程予以檢視。有關長照服務遞送的流程，基於長照服務需求者優先的原則，本文建議從健全績效資訊的觀點，強化分辨機制、建立誘因相容的機制、以及建立內化代理成本的機制，尤其是重新定位長期照顧管理中心的核心職能，以及強化對社區整合服務中心的管理與監督，並在服務流程中納入契約設計的觀點，以使長照服務遞送的功能，更臻健全。

Under the ideal of ＂aging in place＂, the Government has promoted the Long-term Care 2.0 plan in 2017. For an ＂easy-to-find, easy-to-access and affordable＂ system, the Government combined the central government, local governments, NGO, and communities to build a comprehensive ＂social safety net＂, which requires public-private partnership to provide long-term care services. The process of delivering long-term care services equals to the relationship between the principal and the agent, which may cause the principal-agent problems including information asymmetry, hidden action, and hidden information. In order to reduce those problems, it is necessary to examine the process of long-serving service delivery. Based on the principle of long-term care service demander first, this paper tries to give some advices to complete the function of long-term care service delivery, including strengthening the distinguish mechanism, establishing the mechanism of incentive compatibility, establishing the mechanism of internalizing agency cost, positioning the core functions of the long-term care management center, strengthening the management and supervision of the community integrated service center, and incorporating the contract design perspective in the service process.

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