the preliminary plan_of_long-term_care_insurance
TRANSCRIPT
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The Preliminary Plan of Long-The Preliminary Plan of Long-Term Care InsuranceTerm Care Insurance
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OutlineOutline
Origin Background Preliminary Scheme
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OriginOrigin
～ 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.
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:
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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BackgroundBackground
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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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Year
Population over 65 years old
population between 65 to 74 years old
Population over 75 years old
number(million)
Proportion of total
population (%)
number (million)
Proportion of
population over 65
(%)
number(million)
Proportion of
population over 65 (%)
2008 239.7 10.4 136.5 57.0 103.2 43.1
2018 348.0 14.7 202.8 58.3 145.2 41.7
2028 536.1 22.5 314.7 58.7 221.5 41.3
2056 761.6 37.5 306.9 40.3 454.7 59.7
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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00.2
0.4
0.6
0.81
1.2
1.4
1.6
1.8
1999 2000 2002 2004 2007
Average Numberof Birth
NumberNumber
YearYear
2.8
2.9
3
3.1
3.2
3.3
3.4
3.5
1996 2000 2002 2004 2007
Average ResidentsPer Household
Number per Number per householdhousehold
YearYear
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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
396,937449,561
580,814
811,971
294,717335,883
454,472
686,789
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
2008 2011 2018 2028
Total numberof disability
Number ofdisability over65 years old
Reference: The assessment of the need s of long term care service in Taiwan, Yun-Tung Wang( 王雲東 ) et al, 2009
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Comparison of The Main Types of Long-term Care System
Tax qualified long-term care insurance
e.g. North Europe
Public long-term care insurance e.g. German, Austria, Japan, Netherland, Korea
Private long-term care insurance
e.g. U.S.A
Service supply
Raising financial resources
Public sectorPublic sector
Private sector Private sector
Reference: Lin, Chih-Hong （林志鴻） , 2009
Private sector Private sector
Public sectorPublic sector
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Preliminary SchemePreliminary Scheme
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Construction of Long-term Care Insurance
SystemSystem: Single social insurance
Single financial resource Partition management Local services
InsurerInsurer: Bureau of national health insurance
Insured personInsured person: Plan A: Entire people Plan B: Citizen over 40
years old of age
EligibilityEligibility: Physical or mental disabilities in need
Financial resourcesFinancial 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 personInsured person Organization and legal systemOrganization and legal system Service delivery Service delivery Levels and package of benefits Levels and package of benefits Benefit standardBenefit standard Financial resourcesFinancial resources Accompanying MeasureAccompanying Measure
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Insured PersonInsured PersonInsured person
Service object Considerations Covered population
A Entire people
The elderly and Physical
or mental disabilities in
need
1.Any age may have long-term care needs 2.The people younger than 40 years old
have low probability of disability so that the incorporation of burden isn’t high.
3.The object is consistent with national health insurance
23.29 million
People
(100 ％ )
B Citizen over 40
years old of age
The elderly and those who
with the aging-related
diseases
1.It belongs to the group of highest probability of disability and needs
2.Most of them have the burden of responsibility to care and willing to pay premium for parents and themselves in the future. However, it possibly cause employment discrimination.
3.The disability younger than 40 years old have to get care service through the welfare system.
10.52 million people
(45 ％ )
* Due to limited data, current estimates of the number of disability doesn’t include the non-physical barrier dysfunction of the psychogenic disorder, mental retardation, autism and other mental dysfunction
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The Legal SystemThe Legal System
NameName ContentContent
Long-term care insurance law
Long-term care service law
Definition and norm for the insurer, insured person, finance, benefit, service agency, and general rule.
Qualifications, quality norms and criteria of evaluation for the long-term care facilities management, facility supply and demand, setting standards, service providers.
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OrganizationOrganization
Executive Yuan
Department of HealthLong –term care insurance preparatory task force
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 DeliveryService 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.
Receiving unit screen
Assessment
Requirements classification and benefits identify
The insured apply
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Level and Package of benefitsLevel and Package of benefits
•Day care•Community rehabilitation
•Day care•Community rehabilitation
•Transportation, assistive devices •Nutrition, meals-on-wheel service •Care consultation, pharmacist consultation, nutrition counseling •Free care course and support for care givers
•Transportation, assistive devices •Nutrition, meals-on-wheel service •Care consultation, pharmacist consultation, nutrition counseling •Free care course and support for care givers
Other (innovative) servicesOther (innovative) services
•Home nursing•Home rehabilitation•Home service•Respite care
•Home nursing•Home rehabilitation•Home service•Respite care
Home careHome care
•all-day accommodation care
•all-day accommodation care
Institutional care Institutional care Community careCommunity care
Level 3 Level 2 Level 3Need further
supportDegree of disability
Benefits in-kindBenefit package
It needs to be further
evaluated whether to
include insurance
benefit
Only disability level 3 can apply
People hiring foreign caregivers are not allowed to apply
Benefits in-cash
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Benefit Design PrinciplesBenefit 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 BenefitsType of Benefits
Benefits in cash
Benefits in kindType of benefits
People hiring foreign caregivers are not allowed to apply
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Formula of Benefits In-cashFormula of Benefits In-cash
30 ％ of benefits in-kind
30 ％ of benefits in-kind
AA40 ％ of benefits in-kin
d40 ％ of benefits in-kin
d
BB The financial burden of
formula B is 5%more
compared with A
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.
Accompanying Measure
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Remittance according to economic capacity
Setting upper limit of co-payment
Remittance according to economic capacity
Setting upper limit of co-payment
Financial ResourcesFinancial Resources
10 ％： Co-payment
90 ％： Premium
government subsidy
Employer
The insuredLevy with health
insuranceFinancial resource structure
User charge
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.
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Feasible alternatives ofFeasible alternatives of Premium Allocation RatePremium Allocation Rate
Proposal IIProposal II
1. The proportion of government subsidy for all people are the same.
2. The burden ration of employee and employer are the same.
3. The apportionment proportion of employee are the lowest to reduce the implementation of resistance
1. The proportion of government subsidy for all people are the same.
2. The burden ration of employee and employer are the same.
3. The apportionment proportion of employee are the lowest to reduce the implementation of resistance
Uniform government subsidyUniform government subsidy
Proposal IProposal I
1. Identical with the health insurance, small variety, and easier to propaganda.
2. The argument of the proportion of different types of government subsidies in different still exists.
3. The responsibility of government in health insurance and long-term care are the same.
1. Identical with the health insurance, small variety, and easier to propaganda.
2. The argument of the proportion of different types of government subsidies in different still exists.
3. The responsibility of government in health insurance and long-term care are the same.
c.f. the existing health c.f. the existing health
insuranceinsurance
Remarks :
L: labor
E: employer
G: Government
L :E : G30:60:1030: － :7060: － :40 37:30:33
EmployeeFarmer, Fishermen, Veteran dependents
Other citizens
Average
L :E : G30:30:4060: － :40
37:16:47
Employee
Other citizens
Average
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Accompanying MeasureAccompanying 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~Thank you for your attention~