20150428 LTCI scheme
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Transcript of 20150428 LTCI scheme
Design and Policy Issues of the Universal Long-Term Care Insurance (LTCI) Scheme in Taiwan
Department of Social Insurance Ministry of Health and Welfare
2015.4
Department of Social Insurance Ministry of Health and Welfare
Outline
• Background
• Basic Scheme of the LTCI
• LTC need assessment and benefit determination
• Major policy issues
• Conclusions
1
Department of Social Insurance Ministry of Health and Welfare
Aging population in Taiwan
Reference(data of population after 2014): Taiwan Population projection 2012-2060 (mid-projection),
National Development Council.
0
5
10
15
20
25
30
35
40
45
79 82 101 107 114 145
65歲以上 75歲以上
6.0% 1,411,000
14.6% 3,449,000
22.9% 4,529,000
38.2% 7,548,000
12% 2,809,000
5.3% 1,244,000 2.1%
445,000
Aged.S Super Aged.S
20.0% 4,736,000
7.5% 1,773,000 7.1%
1,490,000
Ageing Society
aged
65 an
d over
(
%)
1990 1993 2014 2018 2025 2056
Above 65 Above 65
3
Department of Social Insurance Ministry of Health and Welfare
Reference(data of population after 2014): Taiwan Population projection 2012-2060 (mid-
projection), National Development Council.
aged 65 and over(
%)
Percent of the elderly in selected countries
Japan
Korea
Taiwan
Germany
Italy
France
Britain
United States
Projection
(year)
4
Department of Social Insurance Ministry of Health and Welfare
65+yrs
15~64 yrs
1 ______ 6.7
2014
1 _____ 3.4
2025
1 _____ 1.29
2060
Aging index (#elderly*100/#<=15 yrs)will
increase from 83.4% in 2014 to 401.5% in 2060
Growing dependency
(Source: National Development Council,2012)
15.8% 29% 78%
5
Department of Social Insurance Ministry of Health and Welfare
Projected number of people live with Disability, MOHW
Reference: The projection is the disability rate from The National Long-Term Care Need Survey (phase I) to multiply the mid-projection number of people in 2012 from Taiwan Population projection 2012-2060, National Development Council.
-
20
40
60
80
100
120
75.5
78
89
120
48 50
62
95
2015 2016 2021 2031 Disability Rate 3.36% 3.45% 3.94% 5.30%
6
Per 10000
Department of Social Insurance Ministry of Health and Welfare
The Cumulative Risk of Disability in each age
Source:The statistics is the disability rate from The National Long-Term Care Need Survey (phase I),MOHW
Risk of disability
7
Department of Social Insurance Ministry of Health and Welfare
Cost of LTC and NHE as % of GDP
Cost of LTC in OECD countries is 0.1-3.6% of GDP (median 0.9%,1/10 of NHE)
Source:OECD Health Data 2010
8
LTC/GDP NHE/GDP
%
Developing a Long-term Care System
2008 2010 2012 2014 2017 2016
Second Stage: Long-term Care Act (2014)
Long-term Care Network (2015)
Three Stages of LTCS Development
Department of Social Insurance Ministry of Health and Welfare
9
Second Stage : Long-term Care Act
Long-term Care Network
Third Stage :
Long-term Care
Insurance
First Stage: Long-term 10-year Care Program
Department of Social Insurance Ministry of Health and Welfare
Disabled benefits not only individually, but also the whole family.
According to the need survey result, there are on average 4.58 people in disabled family.
Family population’s definition: it means people who live in the same family, but not including nurse.
Take 2017 for example, if LTCI applies: Insurance objects benefit directly, 800,000 people
It affects caring burden for families who have disabled living together, 2.86 million people
In total of 3.66 million people; which are 15.6% of the total national population 23.51 million people
10
Department of Social Insurance Ministry of Health and Welfare
Policy agenda Council of
Economic Planning and Development
(CEPD)
CEPD has proposed a Long-term Care Insurance Scheme (Dec,2009)
Department of Health (DOH)
* DOH established the Long-Term Care Insurance Preparatory Task Force in July 2009
* The Task Force is responsible for detailed planning work of the long-term care insurance system
Ministry of Health and
Welfare (MOHW)
* The Department of Social Insurance is responsible for detailed planning work of the long-term care insurance system after the governmental reorganization in July 2013.
Note:CEPD on January 22, 2014 for the restructuring of the National Development Council(NDC); DOH on July 23, 2014 for the restructuring of the Ministry of Health and Welfare(MOHW).
12
Department of Social Insurance Ministry of Health and Welfare
Central Authorities
Ministry of Health and Welfare
Insurers National Health Insurance Administration
Related organization
Long-Term Care Insurance Committee
National Health Insurance Dispute Mediation Committee
Name Content
Long-Term Care Insurance Law
Long-Term Care Service Law
For the insurer, the insured, insurance finance, insurance benefits and payments, insurance services institution, general principles and other basic matters of definition and specification
Long-term care service system, institutions and personnel management, service recipients of rights protection, and general principles and other basic matters of definition and specification
Organization Legal system
Organization and legal system
13
Department of Social Insurance Ministry of Health and Welfare
Long-term Care Insurance in Taiwan -goals and the system
Goals -Universal coverage (equity)
-Provide basic, affordable & accountable LTC
-Reduce Family burdens
-Facilitate independent living ,maintain or prevent
loss of functions System design
-Social insurance scheme
-Single payer system (NHIA)
14
Department of Social Insurance Ministry of Health and Welfare
Basic scheme of LTCI -Coverage decision
• Universal coverage
– Cover all citizens with physical /cognitive/mental functional limitation
• most equitable ,no discrimination against age or type of disability,
• Low adm cost & premium rate, high feasibility
– Those aged over 40 years accounted for 51% population
• Three years waiting period for oversea citizens
15
Department of Social Insurance Ministry of Health and Welfare
Basic scheme of LTCI -Benefits
Community&
home care
Institutional
care
Caregiver
support
Others
Home services*
Home nursing
Home Rehabilitation
Day( Night) care
All-day accommodation (for severe cases only)
Respite care
Training courses
Care counseling
On-site visits
Assistive devices
Home- environment improvement
Transportation
New, approved service
*Alternative: cash payment: to facilitate choices, respect care-work, reduce cost, support care-givers, home services may be totally or partially provided by family members and receive cash payment, yet caregivers should render training and monitoring.
16
Department of Social Insurance Ministry of Health and Welfare
Netherland Germany Japan Korea Taiwan
Date( pass
Bill/launch)
1967/1968
1994/
1995 1997/
2000
2007/
2008
Enrollment All age All age ≧40yrs All age All age
Beneficiary All age All age
Elderly or
w geriatric
conditions
Elderly or
w geriatric
conditions
All age
Insurer multiple multiple multiple Single
(NHIC)
Single
(NHIA)
Benefit In kind /cash In kind /cash In kind In kind
/cash
In kind
/cash
Social Long-term Care Insurance System: a comparison
17
Department of Social Insurance Ministry of Health and Welfare
LTC need assessment and benefit determination
18
Department of Social Insurance Ministry of Health and Welfare
Basic Scheme of LTCI -Assessment tools
Develop a multi-dimensional Assessment instrument (MDAI)
Methods Literature review, ICF, focus group, expert group, Delphi
technique
Application National LTC need survey Develop Long-term Care Case-mix system As LTCI Need assessment tool ,to determine the level of
benefit(payment) by computer LTC management: to determine staffing ratio compare
diff in utilization, quality and cost we will adjust and develop the appropriate assessment
instrument for different groups 19
Department of Social Insurance Ministry of Health and Welfare
(6 D) Multi-dimensional
Assessment Instrument (MDAI) •ADLs:Feeding、Bathing、Grooming、Dressing、Bowels、Bladder、Toilet
Use、Transfers、Mobility、Stairs
• IADLs:Ability to Use Telephone、Shopping、Food Preparation、Housekeeping、Laundry、Mode of Transportation、Responsibility for Own Medications、Ability to Handle Finances
ADLs & IADLs
•Vision、Hearing、Conscious、Expression、Comprehend Communication
•Health Status、Skin Conditions、Functional Limitation in Range of Motion、Active Diagnoses、Nutritional Status、Special Treatments and Procedures、Pain Assessment、Fall History and Balance、Assistive Technology
Health Conditions and
Special & complex care
•Cognitive(SPMSQ)
•Mood & Behavior Problems(Wandering、Verbal Behavior、Physical Behavior、Disturb Behavior、Repeat Behavior、Rejection of Care、Night & Day Reverse、Self-mutilation & Suicide、Delusional Disorder、Hallucinosis、Phobia & Anxiety、Depression、Aggressive behavior on objects、Other inappropriate behaviors and hygienic concerns)
Cognitive, mental & behavior
Problem
•Living Arrangement、Living Environment
•Social Participation
Environment, social
participation
•Physical Burden、Psychological Burden、Social Burden、Financial Burden Caregiver burden 20
Department of Social Insurance Ministry of Health and Welfare
Groups*
Groupn*
Level of Need
Level of resource Use data
Content of care
Basic personal care *# Nursing care*#
Personal care*# Respite care*# Home rehabilitation*#
Group1* *Recruit 5536 samples: Home, community &institution *conduct need assessment by MDAI & collect staff time from all staffs who provide care to the individuals
Tree analysis (case-mix system)
Development of LTC Case-mix System (LTC-CMS)
21
Department of Social Insurance Ministry of Health and Welfare
Development of LTCI payment standard Payment standard covers every cost
of providing the services(listed as right)
Collect cost information from service units or institutions that provide long-term care from nation to confirm data to set the payment price.
Services relative inputs: considerations
- Technical difficulty - Need to put in some effort or
mental level - The probability of occurrence of
body injury - Perform the service requires a
minimum number of people - Service Hours
Supplies and
appliances
Equipment expense
Miscellaneous & management fee (including transportation fee)
Employment cost
Other cost
Service
items cost
23
Department of Social Insurance Ministry of Health and Welfare
LTCI service delivery process planning
Insured apply
Contact window check the qualification for applicants
and other related applying document Inform
additional document
Or inadmissible
Assessment visits
Computer determines LTC-CMS payment quota and develop care plan
Approve care plan Note1
Connect service
Finish in 30 days
No
Yes The institution branch in counties and cities of
insurer
Accept it or not
Re-evaluation Note.2
Units that responsible
Note1: Care plan includes payment level, payment category, and payment quota and other matters. If insured questions, s/he can apply insurer to re-evaluation.
Note2: Insurer, depends on needs can proceed re-evaluation on insured. If insurance object changes and other factors due to physical and mental function, resulting in long-term care needs change, may also apply for re-evaluation. 24
Department of Social Insurance Ministry of Health and Welfare
Basic scheme of LTCI -Source of financing
• Copayment exemption for the poor, near poor…
• Co-payments are
subject to a ceiling amount
Co-payment
Premium
Levy through NHIA Total LTCI
cost
User charge
Government
subsidy
The insured
Employer
25
Department of Social Insurance Ministry of Health and Welfare
Financial accountability
• Apply Partial-funding system
• 10-year financial balance premium rate
• Reserve fund equivalent to 8 month premium
• Timely adjustment of premium rate
– Regular:average 3 years based on formula
– Special adjustment: plan approved by LTCI Committee represented by payers, providers and government.
26
Department of Social Insurance Ministry of Health and Welfare
Cost containment • Demand-side
– Pre-authorization (need assessment)
– Setting ceiling for LTCI benefits
– Coinsurance
– Out-of-pocket payment
• Room and board in the institutional care
• Supply-side: – Prospective payment per month, visit, pay-for-
performance
– Utilization review, quality monitoring, on-site visit, price disclosure
27
Department of Social Insurance Ministry of Health and Welfare
Public Attitude toward LTC Insurance
Source:「 LTCI Public Opinion Survey Report by MOHW 」
More than 70% of the public support LTCI
21
52
9 11
4 2
26
51
8 9
3 2
23
54
7
10
3 3
27
51
3
11
4 4
31
50
3
9
3 3
0
10
20
30
40
50
60
ExtremelyApproval
Approval No Comment Disapproval ExtremelyDisapproval
Unknown
2010(Annual)
2011(Annual)
2012(Annual)
2013(Annual)
2014(Annual)
28
%
Department of Social Insurance Ministry of Health and Welfare
Current policy issues
• Political will: fiscal feasibility of the state
• System selection: social insurance vs. taxation schemes
• Worry about shortage of LTC service & personnel-LTC develop fund
• Universal coverage ?
• Attitude of employers to pay premium
• Allow cash payment option ?
29
Department of Social Insurance Ministry of Health and Welfare
Conclusions • LTCI is a highly supported policy, yet provoke hot
debates among stakeholders
• The design of the LTCI benefits accommodated the opinion of different stakeholders
• The implement of the LTCI will rely on:
– Establishment of regional LTC network & workforce
– Financially accountable LTCI scheme
– The Financial burden of the Government
– The degree of aging population
– Social acceptance 31