Introducing social insurance for long-term care in Taiwan: Key issues Nadash P, ShihY.-C. Introducing social insurance for long- term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement secu- rity, and unemployment insurance, by introducing long-term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, parti- cularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastruc- ture and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan’s heavy reliance on foreign workers. Taiwan’s increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to imple- ment LTC reform. Key Practitioner Message: • Emphasizes the importance of policy learning from other environments;• Highlights the need for a strong regulatory and provider infrastructure for delivering long-term care services;• Emphasizes the need for training, support, and appropriate regulation of the long-term care workforce. Pamela Nadash, Yao-Chi Shih Gerontology Institute, University of Massachusetts, Boston, Massachusetts, USA Key words: long-term care, social insurance, aging, East Asia, social welfare policy, home care, disability Pamela Nadash, Department of Gerontology, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, Massachusetts 02125, USA E-mail: pamela.nadash@umb.edu Accepted for publication November 4, 2011 Introduction Taiwan attracted considerable attention when, in 1995, it implemented a universal health insurance program. Yet, this was only one step in its progress toward a comprehensive social safety net, which reaches completion with its most recent reform initiative: uni- versal coverage for long-term care (LTC), funded through premiums paid jointly by employees, employ- ers, and government, with an implementation goal of 3 to 5 years. Although the program will cover institu- tional care, it will emphasize home- and community- based services and aim to support family caregiving. This study discusses key policy issues faced in devel- oping comprehensive LTC insurance (LTCI), given Taiwan’s poorly developed LTC infrastructure. Across the world, populations are aging. While attention has been paid to aging-related public policy issues such as retirement security and health care costs, less has been paid to the need for LTC, that is, ongoing services and supports for people with chronic and dis- abling conditions who require assistance with activities of daily living such as bathing and eating. However, countries are increasingly introducing or expanding their LTC programs (Colombo, Llena-Nozal, Mercier, & Tjadens, 2011). Notable cases include Japan, where about 23 percent of the population is currently 65 or older (Central Intelligence Agency, 2011a); Germany, which has a 16-year history of public LTCI; and Sweden, which spends the most on LTC – and has the highest proportion of persons over 60 years of age in the EU (Organization for Economic Co-operation and Development, 2005). Coverage is rarely comprehen- sive: benefits may be income related, as in France (Le Bihan & Martin, 2010) where a substantial market for private LTCI has evolved, or the system may not fully cover the cost of care, as in Germany (Rothgang, 2010). In practice, of course, all systems of LTC are heavily subsidized by the unpaid labor of informal caregivers (mostly female family members), which comprise most LTC. Even the USA, which has been slow to tackle this issue and currently relies on means-tested and locally determined services, has taken action: under the recently passed Community Living Assis- tance Services and Supports (CLASS) Act (part of the 2010 health care reform legislation), a form of public DOI: 10.1111/j.1468-2397.2011.00862.x Int J Soc Welfare 2012: ••: ••–•• INTERNATIONAL JOURNAL OF SOCIAL WELFARE ISSN 1369-6866 Int J Soc Welfare 2012: ••: ••–•• © 2012 The Author(s) International Journal of Social Welfare © 2012 Blackwell Publishing Ltd and the International Journal of Social Welfare. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA 1