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274 Taiwan Development Perspectives 2009
Background
Taiwan is aging fast. Those aged 65 and above
accounted for more than 10.2 percent of its population
in 2006. They will make up 22 percent of the population
by 2016.
One important reason is a decline in marriage.
Fewer and fewer young people are willing to get married.
Altogether 77.3 percent of the women aged 25-29
were married in 1983, against a mere 47 percent in
2001. Fewer marriages mean fewer children. More serious,
the married couples prefer not to have children.
So, the fall in fertility is the main reason for the
rapid aging of the population. The fertility rate was
only 1,115 per 1,000 women in their lifetime in 2006, a
sharp decline from the 1,680 in the year 2000. It is far
less than two per woman to keep the population from
declining.
Still another reason is the advancement in healthcare.
People live longer. The aged people often need
long-term care.
Need for Long Term Care
Most countries use ADLs (Activities of Daily Life)
to evaluate the need for long-term care. If one cannot
perform one or two ADLs, it is “light disability.”
Failure to perform three or four ADLs is “medium disability,”
while “severe disability” describes an inability
to perform five ADLs or more. The kind and amount of
necessary care – such as home care, community care or
institution care – are determined by the level of ability
and the family setting of those who need it.
There were 330,000 people in Taiwan who needed
long-term care in 2006. They represented 1.45 percent
of the population. The number of such people will rise
to 378,000 (1.64% of the population) in 2011 and
448,000 (1.93%) in 2016..
for long-term care. Among them are the Elderly Welfare
Act, the Law for Protection of the Physically
and Mentally Disadvantaged People, and the National
Health Insurance Law. Competent government agencies
include the Ministry of the Interior, Veterans Administration,
and National Department of Health. This diversified
competency results in omission or duplication
of coverage as well as in inefficiency. What Taiwan has
to do as its population is aging fast is to integrate all
long-term care programs to make sure that all those
who need such care are provided for.
There are two ways to achieve long-term care for
all. Such care services can be financed either through
taxation or by social long-term care insurance. The Executive
Yuan has decided to adopt social insurance for
long term care. The decision is apt. For one thing, people
of Taiwan are familiar with social insurance for they
are already covered by labor insurance and national
health insurance. People know they have to pay premiums.
For another, their tax burden is not heavy. The
total tax in proportion to GDP is only 14 percent in
Taiwan, much lower than 24 percent in South Korea,
23.1 percent in Japan, 26.4 percent in the United States,
30 percent in Germany, 35.1 percent in France, 39 percent
in the United Kingdom, and 51.1 percent in Sweden.
Compared with OECD nations, Taiwan lacks resources
to finance social welfare and it is best to finance
long-term care for all by insurance.
Prospective
Premier Liu Chao-shiuan has a task force formed
under the Council for Economic Planning and Development
to prepare a long-term care insurance program
which will be launched by 2010 or 2011.
Long-Term Care Insurance
Taiwan has adopted a series of acts that provide