The Preliminary Plan of Long-Term Care Insurance Outline

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The Preliminary Plan of Long-Term Care Insurance
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Outline

• Origin
• Background
• Preliminary Scheme

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Origin
2008.11.25 The predecessor premier of the
Executive Yuan, Liu Chao-shiuan pointed out when
going on an inspection tour of Department of
Health
Long-term care is an important policy of
government. Council of economic planning and
development should propose the draft of long-term
care insurance as soon as possible.
2009.01.21 The predecessor premier of the
Executive Yuan, Liu Chao-shiuan pointed out when
listening to the planning briefing made
by Council of economic planning and development
Department of Health is in charge of the draft
formulation of long-term care insurance.
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Background
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Rapid Demographic Ageing

• In recent Taiwan, the fertility rate decreased
  and the average of life span increased due to
  advance of medical technology, the number and
  proportion of elderly people showed significant
  growth. The problem of demographic ageing became
  more severe.
• The proportion of elderly population exceeded 7
  in 1993 (1.49 million), and it became 10 in 2008
  (2.39 million). It is estimated that the
  proportion of elderly population will reach 22.5
  in 2028 (5.36 million).

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Reference Population estimation from 2008 to
2256 in Taiwan, Council of economic planning and
development , 2008.09
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Family Function Became Poor

• The family structure changed, and members of the
  family reduce mutual support.
• People those who have health care needs have
  difficulty in obtaining appropriate care from
  family in nowadays.

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Number per household
Number
Year
Year
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The Population of Disability Growth

• According to our estimation, the number of
  disability and dementia was about 396,937 in 2008
  in Taiwan. As the population aging, the
  disability population will increase. It is
  estimated to reach 811,971 in 2028.
• The Organization for Economic Co-operation and
  Development (OECD) had estimated the financial
  burden of medical and long-term care of member
  states in 2006. It found that the average ratio
  of health and long-term care expenditure to GDP
  will be from 6.7 in 2005 to 12.8 in 2050 in
  demographic ageing situation.

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The Population of Disability Growth
Reference The assessment of the need s of long
term care service in Taiwan, Yun-Tung Wang(???)
et al, 2009
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Comparison of The Main Types of Long-term Care
System
Service supply
Public sector
Private sector
Tax qualified long-term care insurance e.g.
North Europe
Public sector
Public long-term care insurance e.g. German,
Austria, Japan, Netherland, Korea
Raising financial resources
Private sector
Private long-term care insurance e.g. U.S.A
Reference Lin, Chih-Hong(???), 2009
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Preliminary Scheme
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Construction of Long-term Care Insurance

• System Single social insurance
• Single financial resource
• Partition management
• Local services
• Insurer Bureau of national health insurance
• Insured person
• Plan A Entire people
• Plan B Citizen over 40 years old of age
• Eligibility Physical or mental disabilities in
  need

• Financial resources For risk-sharing according
  to the law of large number, premiums for the
  financial resources as follows
• Object of insurance
• Employer
• Government
• Assessment It tends to apply for bureau of
  national health insurance , and could contract
  out processing include local government.

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The Preliminary Plan of Long-Term Care Insurance

• Insured person
• Organization and legal system
• Service delivery
• Levels and package of benefits
• Benefit standard
• Financial resources
• Accompanying Measure

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Insured Person
Due to limited data, current estimates of the
number of disability doesnt include the
non-physical barrier dysfunction of the
psychogenic disorder, mental retardation, autism
and other mental dysfunction
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The Legal System
Name
Content
Definition and norm for the insurer, insured
person, finance, benefit, service agency, and
general rule.
Long-term care insurance law
Qualifications, quality norms and criteria of
evaluation for the long-term care facilities
management, facility supply and demand, setting
standards, service providers.
Long-term care service law
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Organization
Long term care insurance preparatory task force
Department of Health
Local authorities
Bureau of national health insurance
Long-term care insurance committee
Long-term care insurance dispute mediation
committee
mission organization
Subordination institution
Possible entrust institution
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Service Delivery

• After the commencement of long-term care
  insurance , people must first make payment
  obligation. when an accident causing disability ,
  they can get benefits through a needs assessment
  and care management system according to their
  degree of disability.

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Level and Package of benefits
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Benefit Design Principles

• Initially benefits in-kind is as the main
  measure, and benefits in-cash is as the
  supplementary measure. However, the planning of
  benefits in-cash should have proper supporting
  measures to avoid abuses happening.
• It will be evaluated and adjusted according to
  the insurance processing conditions and long-term
  care system development situation during medium
  and long term, and retain the possibility of
  resumption of benefits in-cash.

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Type of Benefits
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Formula of Benefits In-cash
The financial burden of formula B is 5more
compared with A
A
B
30 of benefits in-kind
40 of benefits in-kind
Accompanying Measure

• It needs complementary measures when requesting
  the benefits in-cash, including the qualification
  requirements for the caregivers of eligibility,
  training, and related support. The insurer should
  regularly monitor the condition and quality of
  service delivery, and change to benefits in-kind
  instead of benefits in-cash when necessary.
• The person applying for benefits in-cash can also
  apply for benefits in-kind except home care, day
  care, and accommodation care.
• The setting of benefits in-cash should be prudent
  to avoid affecting the willingness of people to
  use in kind services.
• People hiring foreign caregivers are not allowed
  to apply for benefits in-cash but only benefits
  in-kind.

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Financial Resources

• The premium rate and the financial burden of
  government need to be actuarial confirmed, and
  that how to secure financial resources in the
  future also needs further assessment.

government subsidy
90Premium
Employer
The insured
Financial resource structure

• Remittance according to economic capacity
• Setting upper limit of co-payment

10Co-payment
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Feasible alternatives of Premium Allocation Rate
Proposal II
Proposal I

Uniform government subsidy
c.f. the existing health insurance

Remarks L labor E employer G Government

• The proportion of government subsidy for all
  people are the same.
• The burden ration of employee and employer are
  the same.
• The apportionment proportion of employee are the
  lowest to reduce the implementation of resistance

• Identical with the health insurance, small
  variety, and easier to propaganda.
• The argument of the proportion of different types
  of government subsidies in different still
  exists.
• The responsibility of government in health
  insurance and long-term care are the same.

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Accompanying Measure

• The treatable or reversible cases are belong to
  the health insurance, and the care cases are
  belong to long-term care insurance.
• Development of sub-acute care (intermediate care)
  
• The national health insurance is in charge of
  certain period of sub-acute care (intermediate
  care)
• The related benefit terms should be planned as
  soon as possible.
• The health insurance should be compatible with
  the reform
• The part could be attributable to long-term
  insurance in health insurance includes long term
  home care (professional nursing ) and long term
  social hospitalization.
• For the effective use of resources, the benefit
  and payment system should be reformed
  synchronously .
• Development of integrated care service model
• Integrate the medical and long-term care service
  through a comprehensive assessment and integrated
  care providers plan (with care management).

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Thank you for your attention