Long-term care system in Taiwan: the 2017 major reform and its challenges

Abstract

This paper reviews the past development of the publicly funded long-term care (LTC) system and aims to advance further discussion of LTC in Taiwan. The Ten-year Long-Term Care Plan 2.0 introduced in 2017 calls for a major reform of a publicly funded LTC system in Taiwan. The reform expands on the previous universal tax-based LTC system, allowing for more comprehensive and accessible subsidies on LTC services. This paper provides a brief overview of the political context of the reform and an introduction to the legal basis, financing and delivery mechanisms of the reform plan. To this end, as a preliminary evaluation, this paper identifies major institutional and socio-cultural tensions that could challenge the implementation of the plan. Institutional tensions include the dominant foreign worker caring model, which relies on approximately 220,000 foreign workers to provide LTC services, and the discontinuity between health and social care governance, which leads to a discontinuity between curative and LTC care. Socio-cultural tensions focus on conflicting values in the allocation of responsibility of care and in the understanding of disability between universal social citizenship in the modern state and traditional Confucian ethics. Policy implications of these tensions for the LTC system are then discussed.

Long‐Term Care Insurance Adoption in East Asia: Politics, Ideas, and Institutions

“…While the DPP initially supported the LTCI (Taipei Times ), after coming to power in 2016, the DPP formally aborted the implementation of the LTCI in 2017 and instead made efforts to undermine the LTCI by promoting an LTC Ten‐Year Plan 2.0 (Yeh ). According to Fu (, 92),

However, details of the plan are under construction.

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Political and Cultural Foundations of Long-term Care Reform Comment on "Financing Long-term Care: Lessons From Japan"

“…17,18 The conflicting values between universal citizenship and the traditional Confucian care model would bring cultural tension to LTC reforms. 19 In universal citizenship, which is the model adopted by most publicly-funded LTC systems, citizens are equally eligible to receive LTC services based on their needs; while in the Confucian model, the responsibility for care is differential: it is first the responsibility of direct family members (eg, adult children of older parents in need) and second of other relatives (eg, siblings, adult children of siblings); lastly, public money only pays for those who are left outside the familial network or are in poverty. These two opposite normative values on the allocation of responsibility for care should be addressed by policy reformers.…”

An Intelligent Clinical Decision Support System for Assessing the Needs of a Long-Term Care Plan

“…Information from Tier A and Tier B is then sent to the long-term care station in Tier C for providing various care functions to the elderly. Therefore, the care managers in Tier A play an important role in LTCP 2.0 in evaluating the needs and formulating care plans [7]. However, it is complicated for care managers to perform the tasks of health assessment, reviewing historical health records and resources planning in a short time.…”