Exploring policy and financing options for long-term care in Taiwan

Policy and financing arrangements for long-term care are important themes in each country and/or region, and Taiwan, with its unique historic and politico-economic background, can be regarded as a bridge between well-developed and under-developed countries. Policy formulation about long-term care in Taiwan involves several agencies in the government, including Ministry of Health, Interior Affairs, Education, Insurance Bureau, and Economic Council, and formulation of policy objectives has progressed considerably in the last five years. Financing arrangements are less well-developed because the National Health Insurance Program began only in 1995, and most long-term care is not yet covered. As demand for long-term care exceeds supply, and this gap will grow in future, current resource allocation measures are concerned to facilitate the expansion of community care rather than allowing institutional care to absorb more resources. Developing future financing options is now a central task for policymaking, and government must continue to take a leading role in consolidating financial and integrating the service systems.     

Designing home care benefits: the range of options and experience

This article presents a framework identifying important home care benefit design decisions and reviews existing designs that have been adopted in practice. Four basic designs were identified, based on a review of 55 home care benefits drawn from public programs in the United States and foreign countries, and from private long-term care insurance policies in the United States. Three of these designs-service entitlements, managed-service benefits, and cash disability allowances--have each been adopted by public programs in the United States and abroad, and by private insurance policies in the United States. A fourth design--individualized cash benefits--has been adopted in only one experimental program. The designs observed in practice are remarkably varied, providing evidence that many alternative designs are feasible. Experimentation, particularly with cash disability allowances, is needed to determine the relative costs and benefits of various designs.     

The conditions for state action in Florida's health-care market.

Despite the lack of confidence in government agencies to operate a nationalized health-care system in the United States, government agencies have significantly influenced the distribution and financing of health-care services in the market. Using the State of Florida as a case study, we examine the conditions under which a state health-care agency can consistently influence health-care market arrangements. We examined records from Florida's legislative sessions between 1965 and 1993 focusing on 27 legislative initiatives to involve the state's health-care agencies in the health-care services market. Using Boolean qualitative comparative analysis (QCA), we examined the conditions that facilitated or inhibited legislative policy initiatives for state action in Florida's health-care services market. The cohesiveness of state administrative agency and legislative leadership is of primary importance. Fragmented interests among health-care providers and fiscally legitimate policy positions, whether those of state agencies or health-care providers, are important enabling factors for state action.     

Policy options: early intervention services for substance-exposed infants.

Substance-exposed infants, or babies that have been victims of their mothers' drug use during pregnancy, have reached substantial proportions. Currently, no comprehensive public policy exists to deal with these infants as they enter a society unprepared to respond to an issue increasingly fraught with substantial adverse economic, social, and political ramifications. In order to address the needs of this emerging sub-population, California's governor and state legislature must develop and adopt a concerted interagency policy which outlines: a) uniform criteria for local health care workers, social service agencies, and educators; b) consistent guidelines governing the exchange of information among a range of agencies, including hospitals, schools, and other public and private agencies; and c) increased prevention and early intervention services for these babies and their families. Addressing the needs of these infants requires a bold, comprehensive, interdisciplinary approach from the creators of public policy.     

Connotative meanings assigned to contraceptive options.

Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.     

Reassessing strategies for financing education in South Africa

The paper outlines some alternative education financing strategies for South Africa that need considering given the growth in enrolments at all educational levels, particularly in the face of the continued recession. It is argued that in the long term, while the eradication of apartheid and the creation of a single education ministry undoubtedly will generate resources that currently are being wasted on a multiplicity of education systems and a bloated bureaucracy, the magnitude of the task facing educationists in terms of student numbers suggests that initiatives other than public sector financing may well be required, A review of policy options being formulated for developing countries is provided. However, the development of such strategies for South Africa must involve a careful consideration of equity implications. One way of addressing the issue of educational inequality is to introduce a redistributive strategy, in which the costs of education are redirected toward the wealthier segments of society. In addition, policy options need to be explored concerning cost recovery, grants and loans and the establishment of an education bank for overall policy coordination.     

Ranking policy options for sustainable development

Sustainable development calls for choices among alternative policy options. It is a common view that such choices can be justified by appealing to an evaluative ranking of the options with respect to how their consequences affect a broad range of prudential and moral values. Three philosophically motivated proposals for analysing evaluative rankings are discussed: the measured merits model (e.g. Chang), the ordered values model (e.g. Griffin), and the permissible preference orderings model (Rabinowicz). The analysis focuses on the models’ potential for making transparent how an evaluative ranking can contribute to a justified choice among options, particularly in situations that involve diverse values as typically found in debates on sustainable development. Such transparency plays a crucial role when policy rankings are going to be used as arguments in political decision processes. The measured merits model is found to have questionable consequences for the concept of sustainability, while the ordered values model calls for an axiological framework that cannot plausibly be spelled out for sustainability. The permissible preference orderings model is more promising. Its formal structure and its ability to deal with value-pluralism provide an interesting re-structuring of the problem of justifying choices in sustainability issues.     

Management of the menopause: integrated health-care pathway for the menopausal woman

Management of the menopausal woman has become controversial since publication of the results of the Women's Health Initiative and the Million Women Study from 2002 onwards. This health-care pathway summarizes the role of hormone replacement therapy and non-estrogen-based treatments as well as alternative and complementary therapies. It is based on the fifth edition of Management of the Menopause and was updated on 5 April 2011.     

Japan's financing system for health care of the elderly

The multiplicity of Japan's health insurance system fails to achieve equality among the different insurance groups of the sharing of the financial burden. This "horizontal" inequality is effectively offset by a unique redistribution mechanism established in 1982. However, there is no reserve fund so that savings can be accumulated for the greater financial need in the future. This will inevitably lead to a heavier financial burden for the future working generation or more utilization of the personal assets of the elderly. How to achieve "vertical" or intergenerational equality in financing the cost of health care for the elderly is the biggest social policy challenge for Japan.     

Explorations of the effect of experience on preferences for a health-care service

The standard assumption in economic theory is that preferences do not change as a result of experience with the commodity/service/event. Behavioral scientists have challenged this assumption, claiming that preferences constantly do change as experience is accumulated. This paper tests the effect of experience with a health-care service on preferences for maternity-ward attributes. In order to explore the effect of experience on preferences, the research sample was decomposed into three sub-samples: women pregnant with their first child (no experience); women after one delivery (single experience); and women after more than one delivery (multiple experiences). The preference patterns of the three sub-groups were estimated and compared. A Discrete Choice Experiment (DCE) was employed for establishing the relative importance of five attributes. Socio-economic background variables were also considered. The basic findings are that preferences change significantly as a result of experience with the health event; that the effect of experience is attribute-specific; that the extent of past experience (number of deliveries) is irrelevant; and that the effect of experience differs by socio-economic status.     

Modifying retirement benefits: problems under ERISA.

Discretionary communications to employees regarding retirement benefits must be closely monitored--or else the employer may find its right to modify benefits has been damaged.