1. From ageing to aged : The Experience of Taiwan Chi Mei Medical Center Vice Superintendent Ching-Yih Lin 2 nd WEST AFRICAN – TAIWAN CONFERENCE 2015 1 st – 2 nd DECEMBER 2015

2. Age Structure Has Changed Differently Across Regions Between 1970 and 2014

3. Most developed countries are aged and even decreasing in population Lancet 2012; 380: 142–48

4. The Population Structure of Taiwan in 2014 Total population: 23.4 millions Female life expectancy at birth (years): 83 Male life expectancy at birth (years): 77 Population aged over 65 : 2.86 millions, 12.22% Aging index: 88.57% (only 49.02% in 2004 ) (population 65+ years/population 0~14 years)*100% Total fertility rate: 1.1% The population will be decreasing in the future.

5. Challenges for Countries with Negative Population Growth (1) Decline in productivity Slow economic growth Unsustainable burdens on public health-care systems

6. Need to have Policies to address ageing and low fertility rate Need to Establish a solid and integrated health-care and long-term care systems Challenges for Countries with Negative Population Growth (2)

7. National Health Insurance in Taiwan Since 1995 Under the jurisdiction of the Ministry of Health and Welfare (MOHW) NHI Supervisory Committee NHI Dispute Mediation Committee National Health Insurance Administration (NHIA) Mandatory, single-payer public insurance system Coverage rate 100% citizens Inmates at correctional facilities are covered Taiwan NHI 2014-15 annual report

8. Creating a Post-acute care service model in Taiwan Taiwan NHI 2014-15 annual report A vertically integrated transfer system that integrates acute care, post-acute care and long-term care 39 medical teams from 129 hospitals are participating in the program, which covers every county and city in Taiwan. At the beginning of trail, stroke patients with complications and comorbidities are mainly targeted. 急性後期照護流程圖 Post-acute Care Flow Chart

9. Initial Assessment of Post-acute Care Services Program The condition of 87% of the patients who had completed their treatment under the program had improved. Barthel Index Score, which averaged below 45 (indicating severe dependency) before the trial, had risen to 60 (indicating moderate dependency) Comparing with other stroke patients in similar condition, the re-hospitalization rate of the trial patients is lower. The program of post-acute care can be beneficial and manageable in Taiwan.

10. Content Long-term care insurance law (in 2014) Long-term care service act (in 2016) Definition and norm for the insurer, insured person, finance, benefit, service agency, and general rules. Qualifications, quality norms and criteria of evaluation for the long-term care facilities management, facility supply and demand, service providers. Implementation of Long-term Care Insurance in Taiwan Taiwan have planned long-term care program largely on the basis of the Japan approach: providing of formal services only, no cash for care.

11. Three-Stage Strategy to Develop an Integrated Care System for the Elders in the Future at Taiwan Taiwan NHI 2014-15 annual report The first: carrying out a “10-year long-term care plan” from 2008 to 2017 and implementation of long-term care insurance law in 2014 The second: passing the “Long-term Care Services Act” and building a long-term care network between 2013 and 2016 The third: seamless convergence of long-term care insurance with the national health Insurance and social welfare system to build a comprehensive social safety net

12. Thanks for your attention