1. 1 The Preliminary Plan of Long-Term Care Insurance

2. 2 Outline  Origin  Background  Preliminary Scheme

3. 3 Origin ～ L ong-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.

4. 4 Background

5. 5 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).

6. 6 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 (%) 2008239.710.4136.557.0103.243.1 2018 348.014.7202.858.3145.241.7 2028 536.122.5314.758.7221.541.3 2056 761.637.5306.940.3454.759.7 Reference: Population estimation from 2008 to 2256 in Taiwan, Council of economic planning and development, 2008.09

7. 7 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.

8. 8 Number Year Number per household Year

9. 9 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.

10. 10 The Population of Disability Growth Reference: The assessment of the need s of long term care service in Taiwan, Yun-Tung Wang( 王雲東 ) et al, 2009

11. 11 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 sector Private sector Reference: Lin, Chih-Hong （林志鴻）, 2009 Private sector Public sector

12. 12 Preliminary Scheme

13. 13 Construction of Long-term Care Insurance  System  System: Single social insurance Single financial resource Partition management Local services  Insurer  Insurer: Bureau of national health insurance  Insured person  Insured person: Plan A: Entire people Plan B: Citizen over 40 years old of age  Eligibility  Eligibility: Physical or mental disabilities in need  Financial resources  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.

14. 14 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

15. 15 Insured Person Insured person Service objectConsiderationsCovered 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

16. 16 The Legal System Name Content 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.

17. 17 Organization Executive Yuan Department of Health Long – 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

18. 18 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. Receiving unit screen Assessment Requirements classification and benefits identify The insured apply

19. 19 Level 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) services Home nursing Home rehabilitation Home service Respite care Home nursing Home rehabilitation Home service Respite care Home care all-day accommodation care all-day accommodation care Institutional care Community care Level 3Level 2Level 3 Need further support Degree of disability Benefits in-kind Benefit 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

20. 20 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.

21. 21 Type of Benefits Benefits in cash Benefits in kind Type of benefits People hiring foreign caregivers are not allowed to apply

22. 22 Formula of Benefits In-cash 30 ％ of benefits in-kind A A 40 ％ of benefits in-kind B B 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

23. 23  Remittance according to economic capacity  Setting upper limit of co-payment  Remittance according to economic capacity  Setting upper limit of co-payment Financial Resources 10 ％： Co-payment 90 ％： Premium government subsidy Employer The insured Levy with health insurance Financial 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.

24. 24 Feasible alternatives of Premium Allocation Rate Proposal 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 Uniform government subsidy Proposal 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. c.f. the existing health insurance Remarks : L: labor E: employer G: Government L :E : G 30:60:10 30: － :70 60: － :40 37:30:33 Employee Farmer, Fishermen, Veteran dependents Other citizens Average L :E : G 30:30:40 60: － :40 37:16:47 Employee Other citizens Average

25. 25 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).

26. 26 Thank you for your attention~