The making of the market-driven long term care system in Taiwan: a political economy analysis

• Main Authors: Sang-JuYu, 余尚儒
• Other Authors: Meei-Shia Chen
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/2njg65

碩士 === 國立成功大學 === 公共衛生研究所 === 102 === Taiwan is becoming an aged society. It is, therefore, imperative to establish a long-term care system. However, we are currently confronted with a marketized long-term care system. Critical studies concerning the marketized long-term care system, as well as marketized healthcare system are many in the literature. Although studies on long-term care abound，those on the making of a marketized long-term care system were few. Further, little attention was paid to the association between the healthcare system and the long-term care system. This study focuses on (1) the making of market-driven long-term care system (2) the association between the marketization of the long-term care system and that of the healthcare system. We utilize methods to address the research question at both macro- and micro-levels. At the macro-level, we use nationwide secondary data to analyze historical transformation. At the micro-level, we conduct a case study of metropolitan Chiayi city, using regional secondary data, participant observation and interviews. We analyze the making of the market-driven long-term care system from the two aspects of service delivery and financing. The service delivery system has two major components, (1) institutional care and (2) home care and community care. The veteran system was not included in our study as it was a closed and independent system from the general long-term care system. The marketization of the long-term care system did not start in earnest until the 1980s, mostly as a result of the neoliberal turn in Taiwan’s state policy. A series of social welfare privatization policies led to the contracting out or outsourcing of the public sector. Meanwhile, the government made all kinds of subsidies to private capital to encourage the participation of private sector in the delivery of long-term care services. As a result, there was a boom in the construction of private institutional care facilities. After 1990s, the market potential of the long term care system attracted the investment of the already marketized medical care industry, accelerating the marketization of the long term care system. In particular, while the government’s subsidy to the public hospitals had been decreasing every year, it has been encouraging these hospitals to convert to nursing home facilities, competing with private institutions. Since then, the marketization process has been speeding up. After 2008, the making of a market-driven long term care system is basically settled: the private sector is dominant in all components of the long term care system, including institutional, home care, and community long term care. In fact, it appears that the long term care institution has become larger and more concentrated. A marketized long-term care system inevitably brought inequality of service accessibility. We also found the unequal distribution of long term care institutional resources. This inequality is strongly associated with the distribution of hospital resources. The regional inequality in home and community long term care resources is also closely related to the distribution of medical resources. These inequality problems are all associated with the marketization of medical care system. Up to now, the way the government responds to the urgent long term care needs has been the implementation of de-regulation policies, opening up the long term care system to private capital. Furthermore, the government has been eager to obtain a sustainable financial support for the long terms care system through the establishment of a national long term care insurance. If we reflect on the historical development of Taiwan’s medical care system, we find that the establishment of the National Health Insurance provided the medical industry with a sustainable financial support, enabling the marketization of the medical care system. This successful historial experience is an important reference for the promotion of the national long term care insurance. As a result, the establishment of Taiwan’s national long term care insurance is a kind of “path dependence”. Based on this analysis, we can predict that Taiwan’s long term care system will continue with its marketization process. More research focused on marketization is greatly needed and this type of research can be the basis on which social reform can be carried out.