3.2 In-Depth Interview
4.5.1 Policy Suggestions
There are some alternative solutions we found from the data analysis to the problem of long-term care financial sustainability. To be specific, the answer to the final research question will be presented in this section.
Firstly, if long-term care industrialization is going to be developed in Taiwan, supplementary measures are indeed essential in order to protect not only labors but also care recipients. Secondly, in order to reach a successful level of integration, not only should the social welfare and health system be integrated, but also labor policy and the actual business content. Thirdly, pursuing the goal of long-term care customization, long-term care system in Taiwan should be more decentralized. Fourthly, there should be more funds and plans supporting the cultivation of local resources in order to keep not only the talent pool but the human resources. Fifthly, there are still rooms for improvement when it comes to allocation of resources. Despite the subsidies provided by Taiwanese government, creating attractions to promote local resources and assigning cases in strategic ways are also important. Sixthly, on the aspect of administrative process efficiency, a transparent case assigning system is necessary as we want public sectors to trust each other. Furthermore, respecting the improvement of the relationship between public and private sectors, authorities concerned in Taiwan could consider changing the system to spot-check or reporting system rather than going through the trifled processes of write-off system. In addition, it would be more administratively efficient if the policy-makers double check and inspect the goals of every policy and even institution to avoid
Last but not least, suggestions to the financial sustainability scheme for governments in Taiwan and policy-makers would be proposed. Firstly, government in Taiwan should adopt VFM to be a useful help not only for evaluating the current PFI cases but also those in the future. Also, coming up with supplementary measures is important once we decide to implement PFI in order to prevent problems such as information asymmetry. Secondly, learning from Japan, there could be some retrenchment schemes for securing financial affairs in Taiwan.
Finally, there could be prevention plans in Taiwan, which varies across groups like Japanese prevention plans. It means a stratified prevention policy for each group that has different level of needs for care. For example, not only a prevention policy for those not yet in need of long-term care, but also for those severely disabled.
All of the three main research questions are answered based on the public released data and interviews. In the next section, we will give concluding remarks and point out some areas for future research.
Table 7. The Overall Comparison of Japan and Taiwan
Role Governance Structure Service Delivery Finance Scheme Sustainability Scheme Japan Central
Government
1. Industrialized
2. Responsible for the policy making
3. Industrialization is necessary for socialization
4. Failure of integration between medical and long-term care services.
1. Community Integrated Care System
2. Difficult for service delivery due to depopulation.
3. Decentralization helps increase service quality.
4. Implementation of prevention policy.
Local
Government
n.a 1. Introduction of foreign labors to supplement the shortage of human resources
1. Public opinions play crucial roles in deciding whether a policy is good or not, no matter it is a tax one or an insurance one.
1. A sound and supplementary measure should back up the private investment in the long-term care insurance policy
NPO 1. Industrialization is the solution to the difficulty of pursuing large profit for the government.
1. Remote areas should be activated to solve the problem of
depopulation and lacking of human resources.
n.a 1. Retrenchment
Role Governance Structure Service Delivery Finance Scheme Sustainability Scheme Scholar 1. Industrialization is necessary
for long-term care generalization.
2. Failure of integration between medical and long-term care services.
1. shortage of human resources 2. Uneven allocation of resources.
1. Insurance policy is more efficient than tax policy. the people would be.
1. Increase consumption tax 2. Lower the age of category 2
insurers 3. Retrenchment
4. Implementation of PPP 5. Addressing insurance policy
to increase the political support.
6. Implementation of prevention policy.
Taiwan Central Government
1. Not industrialized
2. Responsible for the policy making
3. Integration of Social welfare and health system
1. comprehensive community care service system (Long-term Care ABC)
2. Enrich human resources by establishing Long-term Care Service Development Fund.
3. cultivation and training of local caregivers
4. enrich resources to remote areas by subsidizing transportation for caregivers.
1. Tax policy only 2. Stable tax resources
n.a
Source: This research
Taiwan Role Governance Structure Service Delivery Finance Scheme Sustainability Scheme Local
Government
1. Failure of integration between social welfare and health system.
2. There should be
supplementary measures for industrialization.
3. Industrialization leads the market to a benign
competition
1. Promote the local resources by involving government subsidies.
2. Cultivation of local caregivers
3. A sense of distrust leads to the administration process
inefficiency.
1. Tax policy is necessary for now.
1. Implementation of prevention policy.
NPO 1. Failure of integration between the public sectors.
1. Promote the local resources by involving government subsidies.
2. Decentralization is necessary 3. shortage of human resources
1. Support for utilizing both tax and insurance policies.
1. Implementation of prevention policy.
2. Risk sharing (insurance policy)
Scholar 1. Failure of integration from social welfare, health system, and labor policy to business contents.
2. There should be
supplementary measures for industrialization
3. Industrialization leads to a benign competition
1. Promote the local resources by involving government subsidies.
2. Confusion of roles
3. Decentralization is necessary.
4. Cultivation of local caregivers 5. the overlap of the policy goals
1. support for insurance policy.
1. Implement insurance policy to earn political support 2. prevent information
asymmetry for PPP is important.
Chapter Five- Conclusion
Based on publicly released data and in-depth interviews, we believe that there is still a lot of room for improvement when it comes to the financial sustainability of Taiwan’s long-term care system. By utilizing a comparative institutional analysis approach based on welfare state theory, the four essential aspects were stated to compare with the tool of content analysis and document analysis. In this way, we were able to derive insights into both the manifest and latent content of long-term care policies through interviews with respondents in Taiwan and Japan.
We thereby successfully drew conclusions and identified some areas for future research.
Unlike the Japanese system, Taiwan’s long-term care system has only existed for a few years. However, because the aging trends in Japan and Taiwan are similar, the likelihood that Taiwanese society will face problems similar to those currently occurring in Japan is high. Also, other Asian countries should seriously consider following the Japanese approach to social welfare especially when it comes to long-term care. In addition, according to Esping-Endersen, the welfare regimes in Taiwan and Japan both fall into the hybrid regime category, which encompasses both liberal and conservative regimes. In this case, Japan’s long-term care policies should serve as a model from which the Taiwanese government can learn. This is why we initially chose Japan as a point of comparison for Taiwan. After examining the bigger picture, our analysis generated several noteworthy findings.
Our research reassured us that neither Japan nor Taiwan is neither fully decommodified or universalist. Thus, neither country is yet a social democracy. However, the Japanese regime appears generally more conservative, initiating its insurance policy to address the lack of strong
prevention plans. Due to comparable gradual declines in family support, Taiwan may be better off following the Japanese approach and embracing a more toward conservative regime in which the insurance policy and the stratified policies could serve as alternative policies worth implementing.
Followings are overall policy suggestions for Taiwan:
Increasing Administrative Process Efficiency
Increasing the efficiency of administrative processes is a very effective cost-saving method that can help sustain financing. Initiatives that increase the efficiency of administrative processes include the integration of social welfare and health systems as well as labor policies and business content. In addition, double checking and evaluating all policies could help eliminate policy goal overlaps that could be the main sources of inefficiencies. Moreover, establishing trustworthy systems including a transparent system for assigning cases among public sector institutions and a spot-check or reporting system for both private and public sector institutions would also increase administrative efficiency.
Acquiring Political Support
If people support a country’s long-term care system, they will be willing to both spend money on care and participate in private-public partnerships. This will help solve long-term financial sustainability issues. Bolstering political support will also aid in the implementation of the insurance policy, the creation of robust supplementary measures for initiating long-term care industrialization, the customization of long-term care via decentralization, the cultivation of local resources for human resources, and the creation of attractions for resource allocation.
Implementing Retrenchment and Prevention Plans
To ensure financial sustainability, spending must be reduced from time to time. To be more precise, there must be plans such as benefit cutting to secure the necessary finances. In addition, a prevention plan could also increase financial savings in the long run, and stratified prevention policies may prove the most effective.
5.1 Research Limitations
Long-term care system is an overall and comprehensive cooperation of health care for the elderly; hence, the aspects and the fields involved are relatively wide. Apart from the financial aspects, service delivery aspects and those that are mentioned and discussed in this research, there are still a bunch that are impossible for this thesis to precisely dig deep into; for example, a robust long-term care system also includes the caregiver systems, administrations and professional training systems to name a few.
In the other word, to obtain a sound policy of long-term care system, since finance is one of the key factors, this research only holds the discussion about the aspects that are highly related to the financial sustainability issue; therefore, other factors of long-term care cultivations would not be deeply discussed in this thesis. Besides, in the respect of financial policy, there is also a possible situation which private commercial insurances set the long-term care as a target. Due to the limitation of time and capacity, this thesis would mainly focus on the legal financial affairs of long-term care systems that are carried out by the government.
As the interview data collecting limitation, due to difficulties of interviewing the representatives from the central government in Taiwan, the secondary public released data would be utilized and analyzed along with the primary data in the research. Moreover, there
choose to skip or refuse to answer or even cases which respondents might be unable to answer due to the lack of knowledge to a specific realm. Also, there might be reservations toward the opinions and suggestions in the analyses from the scholars in terms that oftentimes their thoughts could be significantly different.
5.2 Future Research
Before implementing a policy, there must be evaluations toward the feasibilities. For example, PFI is feasible in Japan; however, without making researches about the feasibilities and the possible supplementary measures in Taiwan, it would be hardly possible for us to know if the policy is worth carrying out. Therefore, in order to make long-term care policies in Taiwan more robust and sound, policy analysis and policy evaluations are two areas that can be done in the future works.
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Appendix
Appendix 1. The Total Budget Expectation in Taiwan
Appendix 1. The Total Budget Expectation in Taiwan