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.     

Organization and Delivery of Long-Term Care in Taiwan

Summary

Taiwan reached the World Health Organization (WHO) benchmark of7%aged 65and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.     

Long-Term Care Policy Reform in Japan

Summary

The implementation of Japan's Long-Term Care Insurance Scheme in April 2000 was the culmination of some 30 years of policy deliberation on aged care. Understanding the policy debate surrounding the Long-Term Care Insurance scheme and its financing arrangements requires an appreciation of rapid demographic and social change, especially in family structures and attitudes to caring for aged parents; but the pressures that population aging and economic downturn are placing on Japan's pension and health insurance systems also must be recognized. Even more generally, the delicate balance of political interests in Japan's central governing body, the Diet, has shaped the implementation of Long-Term Care Insurance as a forerunner to other reforms in social security and health insurance.     

Israel's long-term care insurance law after a decade of implementation

Israel's Long-Term Care Insurance (LTCI) law has been in effect for a decade. It is timely to review the effects of this legislation with a view to identifying possible directions for reform and lessons for other countries considering the introduction of a similar social insurance scheme. The paper considers the law's effects in terms of the size and characteristics of the beneficiary population, the coverage of the scheme, its financial standing, the rate of institutionalization of the elderly, the caregiving burden, the service delivery system, and the overall scope of long-term care services for the aged. Israel's experience has lessons for financing arrangements, target efficiency, service delivery arrangements, and the construction of the burden of care.     

The Savings Approach to Financing Long-Term Care in Singapore

Summary

Singapore is grappling with provision of services for the current generation of older people at the same time as building the foundation for the coming generations of elderly. In this article, I analyze four sets of factors that are shaping long-term care policy and financing in ways that are almost unique to Singapore. First, current developments can only be understood in the context of the Central Provident Fund (CPF) that was established by the Government of Singapore in the 1950s to ensure that the working population saved for retirement; the Medisave and related schemes for financing health care were subsequently developed alongside the CPF. Most recently, the existing funding arrangements have been extended to some long-term care services, and options for further extensions are under consideration. Second, the government's philosophy of maintaining the primacy of family support for the elderly has been expressed through a number of initiatives that provide financial and other incentives to families, combined with an emphasis on community care. The third factor is the relationship between government and the voluntary welfare organizations that are the major providers of institutional and community services. Finally, a series of government-sponsored reviews and advisory councils have provided for widespread consultation on policy options. These developments are directed to achieving a multi-pillar approach in which intergenerational transfers through taxation will be limited, and the role of individual savings and insurance will be increased.     

Future of Long-Term Care Financing for the Elderly in Korea

ABSTRACT

With rapid aging, change in family structure, and the increase in the labor participation of women, the demand for long-term care has been increasing in Korea. Inappropriate utilization of medical care by the elderly in health care institutions, such as social admissions, also puts a financial burden on the health insurance system. The widening gap between the need for long-term care and the capacity of welfare programs to fulfill that need, along with a rather new national pension scheme and the limited economic capacity of the elderly, calls for a new public financing mechanism to provide protection for a broader range of old people from the costs of long-term care. Many important decisions are yet to be made, although Korea is likely to introduce social insurance for long-term care rather than tax-based financing, following the tradition of social health insurance. Whether it should cover only the elderly long-term care or all types of long-term care including disability of all age groups will have a critical impact on social solidarity and the financial sustainability of the new long-term care insurance. Generosity of benefits or the level of out-of-pocket payment, the role of cash benefits, and the relation with health insurance scheme all should be taken into account in the design of a new financing scheme. Lack of care personnel and facilities is also a barrier to the implementation of public long-term care financing in Korea, and the implementation strategy needs to be carved out carefully.     

Organization and delivery of long-term care in Taiwan

Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.     

Enabling Informed Consumer Choice in the Long-Term Care Insurance Market

ABSTRACT

Provisions in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) may increase private long-term care insurance sales without imposing substantially more stringent consumer-protection features. The ability of consumers to make informed choices when purchasing this complex product is examined in light of these changes. Data were collected through detailed examinations of policies and interviews with industry experts, insurance companies, agents, consumer groups, and regulators. Because of the complexity of this product, the goals of expanding consumer choice and ensuring that consumers are able to make informed decisions often work against each other. Mechanisms are discussed through which the government can facilitate informed choice and improve consumer protection. The authors contend that, because the government is providing tax incentives that encourage consumers to purchase the product, it has the responsibility to ensure that consumers understand the long-term care insurance they purchase.     

Long-term care policy reform in Japan

The implementation of Japan's Long-Term Care Insurance Scheme in April 2000 was the culmination of some 30 years of policy deliberation on aged care. Understanding the policy debate surrounding the Long-Term Care Insurance scheme and its financing arrangements requires an appreciation of rapid demographic and social change, especially in family structures and attitudes to caring for aged parents; but the pressures that population aging and economic downturn are placing on Japan's pension and health insurance systems also must be recognized. Even more generally, the delicate balance of political interests in Japan's central governing body, the Diet, has shaped the implementation of Long-Term Care Insurance as a forerunner to other reforms in social security and health insurance.     

An International Review of the Long-Term Care Workforce

Abstract

The developed world's population is aging, due to trends of increased life expectancies and decreased fertility rates. These trends are predicted to increase demand on long-term care services. At the same time, the long-term care workforce is in shortage in most of the developed world. Moreover, such shortages are expected to increase due to parallel socio-demographic factors. The increase in demand for long-term care, coupled with shortage in supply of care workers, has promoted some attention from policymakers. The current paper provides an international review of institutional arrangements for long-term care in different developed countries and in particular explores different strategies used or proposed to resolve the shortage in the long-term care workforce.     

Home Is Where the Help Is

Abstract

Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skævinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.     

Long-Term Care Insurance in Japan

Abstract

Among all the industrialized countries, Japan has the fastest rate of population aging and the highest life expectancy at birth. It is projected that the proportion of elderly people will reach 35.7% in 2050. In this demographic environment, Japan launched a social insurance program for long-term care for the elderly in 2000. What were the forces that led Japan to establish a long-term care program for elderly people? What are the provisions for financing, benefits, and service delivery? What aspects of policymaking in developing such a program are unique to Japan? This article presents answers to these questions.     

Impact of the Health Resources and Services Administration’s state oral health workforce grant program on dental workforce density and access to oral health care

BackgroundThe Health Resources and Services Administration’s Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states’ individual needs.AimThis cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding.MethodsWe used data for 2006–2016 SOHWP awardees together with data from the 2016–2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding.ResultsMulti-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West.ConclusionAllowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.     

Familial Factors Associated With the Use of Multiple Child‐Care Arrangements

This study examined the use of multiple, concurrent, nonparental child‐care arrangements among children under 5 with employed mothers in the NICHD Study of Early Child Care and Youth Development (N= 759). Older children, those primarily cared for in informal child care, those living in cohabitating or single‐parent households, and those whose mothers were employed for 40 or fewer hours per week were likely to be in multiple arrangements. Higher quality primary child‐care and lower maternal satisfaction with primary care predicted the subsequent use of multiple arrangements. Little support for income differences in selection into multiple arrangements was found. Findings highlight the importance of child‐care characteristics and structure in child‐care choice. Policy implications are discussed.     

Kinship Care and Public Child Welfare: Challenges and Opportunities for Social Work Education

Abstract

The growing practice of arranging and financing “foster placement” of abused and neglected children with relatives provides an opportunity to redefine relationships between extended families and the child welfare system. The dilemmas and possibilities presented by kinship care as a child welfare service challenge schools of social work to provide intellectual leadership and to prepare social workers for changing child welfare practice. The author's ideas concerning responses to this challenge focus on key mandates of the Council on Social Work Education's Curriculum Policy Statement and on five principal curriculum areas in social work education.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.     

Meaning as outcome: Understanding the complexity of decision-making around residential placement in aged care

Abstract

Changes in aged care and health policy have introduced an increasingly complex assessment, resource option, and economic and regulatory context for decision-making regarding relocation to residential care. This paper reports on a study exploring residential placement from the perspective of spouses who place a long-term partner in an aged care facility. It highlights the importance of understanding the meaning of such decision-making for the spouse who remains at home and explores the ways in which the placement is constructed as either a continuation of, or a refusal to, care for a long-term partner. The paper draws out the implications for social work practice and identifies the challenge to merge knowledge of resource packages, care options and financial arrangements with a concern with the processes of decision-making and the emotional and symbolic aspects of such decisions.