全球快速老化現象給各國帶來龐大的長期照顧財務壓力，長照資源利用之績效亦為重要議題之一。過去台灣以資料庫進行具全國代表性樣本的長照服務利用分析較少見，小樣本的研究也多針對服務選擇而非服務利用時間或滿意度進行追蹤，對於全國整體投入資源與產出下的效率亦多未著墨，為探討我國自2007年開始執行之「我國長期照顧十年計畫」(長照1.0)績效如何，本研究分別從長照1.0含：居家式及社區式服務利用資源供應端之效率、需求者端服務利用之效果及不同社會福利身份別族群服務利用之公平等三個面向探討長照資源利用之績效以作為研究目的，以實際資料提供自2017年起實施之長期照顧十年計畫2.0(長照2.0)之參考建言。

本研究使用政府公開資料與2011-2016年衛生福利部長期照顧管理資訊系統資料庫(LTC-CM，長照資料庫)進行量性研究，以資料包絡分析法(Data Envelopment Analysis, DEA)為基礎之麥式生產力指數(Malmquist productivity index, MPI)檢視台灣19縣市照顧管理中心投入產出效率在2011-2016年間之變化，了解長照供應端服務利用情形及影響因素；並以2013-2015年使用長照服務之個案資料追蹤至少24個月，擷取資料庫中符合安德森醫療服務利用行為模型(Andersen behavioral model)之傾向、使能、需求及環境變項，分析需求者服務資源使用情形及影響其利用時間長短之因素。

研究結果顯示，透過供應端的麥氏生產力指數分析顯示，台灣長照系統效率指數之生產力在2011-2016年期間呈現和緩下降（平均TFPCH 0.945）。儘管技術效率變動實際上因投入增加與行政框架的變化而整體稍有進步（平均EFFCH 1.011），仍無法抵消技術變動指數下降的6.6％（平均TECHCH 0.934）對整體產業的影響。而需求端服務資源利用效果分析結果顯示，政策傾向納入社經地位與教育程度較弱勢者，但會進入長照系統使用服務與會長久使用長照居家式及社區式服務者其身心功能之失能程度皆較輕。且在不同社會福利身份別分群分析之結果顯示，以公平的角度檢視服務資源利用影響因素也是相同的情況不論需求者社會福利身分別為一般戶、中低收入或低收入戶，其使用服務時間皆受到失能程度之影響。

依據長照1.0下居家式及社區式服務資源效率分析結果顯示，未來長照改革方向除持續挹注資源外應著重於技術革新，應更加強化服務提供者與需求者的教育訓練以提升服務品質。居家式及社區式服務需求者對於是否持續利用服務之主要影響因素為身心功能狀況，顯示長照1.0期間所提供之服務無法滿足失能程度較嚴重個案之照顧需求，此趨勢於一般大眾或弱勢族群中皆然。且一般收入戶者較有能力尋求替代資源，因此雖然長照系統已提升弱勢族群長照服務利用之公平，仍需透過長照2.0階段開始增加之專業介入與服務密度的政策持續改善才能實質達成個案在地老化目標。

The aim of this study is to explore the performance of home and community-based services (HCBS) utilization in long-term care plan 1.0 (LTC1.0) by three indicators, i.e. the efficiency of service providers, the effectiveness of HCBS utilization and the equity of HCBS utilization in different social welfare status groups. Data was collected from government's open data and long-term care dataset. The Malmquist productivity index (MPI) based on the Data Envelopment Analysis (DEA) and multiple linear regression was conducted to explore the efficiency changes of 19 cities/counties’ care management centers during 2011 to 2016 and the effectiveness of HCBS utilization and equity in different socialeconomic care recipients groups from 2013 to 2015.

Results of efficiency analysis show that the LTC system had an urgent need of improving technology change. The effectiveness of HCBS utilization shows LTC 1.0 tended to recruit recipients in vulnerable socioeconomic or healthstatus, however, the system couldn’t keep those with moderate to severe disability, and equity analysis of the influencing factors in low and mid-low income recipients show not much difference from overall analysis.

To reinforce the current LTC system, LTC 2.0 reform measures that increase service density and strengthen professionals involvement can be expected to and hence keep recipients with moderate to severe disability in their own communities. On-the-job training for service providers and education for recipients and their families about person centered care may be necessary to improve the overall LTC utilization efficiency.

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