Administrative Process Efficiency

4.2.4 Administrative Process Efficiency

Needless to say, a lack of efficiency is a waste of time and money. Likewise, when it comes to a lack of administrative process efficiency, it would also be a waste of time; namely, the cost increases. To be more specific, as the cost increases in a sense of inefficiency, financial sustainability would be negatively affected.

The local government (T1) and the scholars (T3) and (T4) in Taiwan discussed the potential inefficiency of the administration process toward long-term care. Three main points having led to the inefficiency are mentioned: a sense of distrust, confusion of roles, and overlap of policy goals. However, neither the three points nor any potential elements of administration process inefficiency are mentioned by any one of the Japanese respondents; in this case, we consider it to be a contrast between the two countries. In this way, we discuss the case in Taiwan.

“For the service delivery ‘Long-term Care ABC’, tier A has the right to assign cases to tier B, however, they are both private sectors and tier A doesn’t have the power like the government. So, they are more like a competitive relationship. Because the more cases one takes, the more money the one earns, when tier A is assigning cases to tier B, there will be psychological distrust between them; therefore, there will be disputes. I suggest there should be a transparent case-assigning system; hence, tier B would be able to clearly see how tier A assign the cases…Also there is a sense of administrative process inefficiency when it comes to the execution. The examine and audit, also the write-off system are set on the basis of distrust between the private sectors and the government. In this respect, there are lots of supervision processes. Therefore, it led to the depletion of human resources in the government departments; moreover, private sectors have to

prepare for lots of paper works in order to cooperate…they may as well utilize the way of spot-check or reporting system instead of the inefficient routine…we had visited Japan and they were wondering why we need such a complicated process. More importantly, they don’t have such a problem…if the central government doesn’t make a change, private sectors will no longer coordinate with the public sectors due to the trivial and complicated process.” (T1)

According to the Taiwanese local government, we know that the distrusts between government departments, and those between the government and private sectors had led to the administrative process inefficiency. A transparent case-assigning system and a simplified write-off system seem to be necessary.

Here, two scholars gave insights into the administration process inefficiency arising from the confusion of roles:

“I suggest Taiwan to return the community integration care to the public sector instead of outsourcing. It should be public sectors’ responsibilities because outsourcing causes a lot of function confusions of the roles. Hence, the rights and obligations of care managers and case managers are still unclear, and people would also be confused.” (T3)

“The reason why tier A is eliminated is because of the overlap of the roles, which are the tier A’s care managers and long-term care managers. It’s a problem never been solved since Long-term Care ABC was first planned. For example, after the assessment from the long-term care managers, they still have to submit to Tier A’s care manager, however, we only need one to do the work. A care manager should be someone from the public sector because he/she is responsible for the resource allocation; he/she has to have the authority because he/she verifies the demands.” (T4)

Also, the overlap of the policy goals is the other important cause having been mentioned by the scholar (T3), which would negatively affect the efficiency of the administrative process:

“Communities in Taiwan facilitate health promotion and so do Long-term Care ABC. The community care centers were promoted since 2005, and one of the four elements of the community care center is health promotion. Though funds are from different places, the elderly are the same crowd. Therefore, People won’t be more benefitted by more resources and services. Instead, the old people will be exhausted since they have to attend different places for the same purpose because different health promotion administrations all need to increase performance.” (T3)

4.3 Finance Scheme

When it comes to financial affairs of long-term care, a robust and steady finance scheme would definitely influence a country’s financial sustainability in a positive way. In the other word, the finance resources of long-term care are indeed an important element to discuss about when the goal is to sustain the finance affairs. For this section, we discuss mainly about the tax policy and the insurance policy that both countries have adopted.

The long-term care financial affairs in Taiwan are mostly from gift tax, and tobacco tax;

also others are from Health and Welfare Surcharge of Tobacco Products (菸害健康福利捐), donations, funds, and other incomes. Furthermore, if there is still lacking, government’s budget will be a support in order to reach the first step goal of promised 33 billion NTD. According to chapter 1, article 15 of Long-term Care Service Act (2017), Taiwan’s long-term care finance scheme has changed since the year 2017. Though it is still the tax policy, the government increased the gift tax from the original 10% to the highest 20%; they also increased the tobacco tax from 590 NTD/Kg to 1590 NTD/Kg.

For the long-term care finance scheme in Japan, they are different from Taiwan’s tax policy. Instead, they have the policy of both long-term care insurance and tax, which divided the funds into half, tax and premiums. From graph 21, we could see that they have the government, municipalities, and prefectures to share the tax in order to reach the balance of

long-term care finance affairs. The other half, however, is from the premiums. According to the Long-term care insurance law article 9, people that are 65 years old or older and with a residence are called “category 1 insured”. Category 1 insured is responsible for 17% of the premiums for the long-term care. For those that are aged between 40-64 with a residence are called “category 2 insured”, and they are responsible for the other 33% of the premiums.

Graph 21. The Finance Scheme of Long-term Care Insurance in Japan

Source: Ministry of Health, Labour and Welfare

When speaking of the finance scheme of Taiwan, the tax and insurance policy is considerably a controversial issue worth discussing. Hence, we would be analyzing the interview data and seek insight into the preferences of the respondents in both countries. In this sense, it would be more clear for us to know which policy is more suitable for the case of Taiwan.