Long-term Care Insurance Planning by Delphi Technique

• Main Authors: Liu hui-rong, 劉慧蓉
• Other Authors: Kao Senyeong
• Format: Others
• Language: zh-TW
• Published: 2000
• Online Access: http://ndltd.ncl.edu.tw/handle/23530979410616872494

碩士 === 國防醫學院 === 公共衛生學研究所 === 89 === This research is conducted by “Delphi Technique” which collects meritocracies’ opinions on associated issues of Taiwan’s long-term care insurance plan. The meritocracies include representatives from the long-term care industry, in-charge officers from related government departments (Health Department and Ministry of Interior), and scholars and professionals of related fields. After three rounds of surveying, these meritocracies’ opinions on issues of long-term care insurance (15 questions and 80 items) achieve a 96.25% agreement (77/80). Within the study, 58.75% (47/80) is considered to be “highly agreed” (Q<=0.5); and 37.5% (30/80) is considered to be “moderately agreed” (0.5<Q<=1). The following contents are the abstracts of important findings and recommendations. [1]Reasons for implementing long-term care insurance Among all reasons supporting the implementation of long-term care insurance in Taiwan, the following factors have high degree of agreement. -increasing demand for long-term care (aging population); -supporting establishment of consecutive care system; -advantage of insurance over social relief; -capability of carrying out continuous management; -more rationalized resource allocation; -relieving problems occurred in life cycle such as risk and economical difficulty of long-term care, family structural change, and insufficient care workers; -financing long-term care budget; -distributing budgets independently; -unifying social welfare and health executive matters; -re-organizing every organization. From the above factors, the one with the greatest importance is increasing demand for long-term care (aging population) (Q3~Q1=5~5, average = 4.91); and the ones with the least importance are unifying social welfare and health executive matters and re-organizing every organization (Q3~Q1=4~3, average = 3.3). [2]Problems to be solved before implementation of long-term care insurance The following are the problems to be solved before implementing long-term care insurance. The problems with high degree of agreement include: -establishing joint-administration and coordination channel between social welfare and health executive systems; -having sufficient sources supplying care workers and equipment; -developing a well-designed financial system; -insurance policies; -setting operational principals for payment regulations; -integrating social welfare and health executive systems and enhancing administration guidance for long-term care facilities; -rationalizing existing long-term care facilities’ founding standards; -clarifying relationship between national health insurance and long-term care insurance; -administrating and guiding non-registered care centers; -investigating on quantitative changes of long-term care demand. Among these problems, the one with the greatest importance is establishing joint-administration and coordination channel between social welfare and health executive systems (Q3~Q1=5~5, average = 4.78); and the one with the least importance is investigating on quantitative changes of long-term care demand (Q3~Q1=4~3, average = 3.91). [3]Questions related to financing long-term care insurance Findings on the questions related to budget financing are: (1)In the aspect of system options: making long-term care insurance as an additional insurance attached to the national health insurance or national pension system are the ones with high degree f agreement. Having it as national health insurance’s attached insurance is of the greatest importance (Q3~Q1=5~4, average = 4.50); and having it as national pension system’s attached insurance is of the least importance (Q3~Q1=4~3, average = 3.52). (2)In the aspect of funding methods, combination of general revenues and premiums, partial coverage, and premium collection have high degree of agreement. Premium collection has the highest level of importance (Q3~Q1=5~4, average = 4.19), and partial coverage has lower level of importance (Q3~Q1=4~4, average = 3.81). [4]Determination of the insurant of long-term care insurance In terms of determining the insurant of long-term care insurance, commonalty has high degree of agreement (same as the existing national health insurance). Commonalty is also of the greatest importance (same as the existing national health insurance) (Q3~Q1=5~4, average = 4.64). [5]Type of insurance for long-term care insurance In terms of type of insurance, mandatory type (must enroll) has high degree of agreement. It is also of the greatest importance (Q3~Q1=5~4, average = 4.55). [6]Planning and administrating institutions of long-term care insurance In the aspect of planning body, the entities with high degree of agreement include: an independent inter-ministry group that consists of three authorities (Health Department, Ministry of Interior, and Economic Development Committee); Health Department; and Ministry of Finance. The independent inter-ministry group that consists of three authorities (Health Department, Ministry of Interior, and Economic Development Committee) is of the greatest importance (Q3~Q1=5~4, average = 4.03); and Ministry of Finance is of the least importance which indicates that Ministry of Finance is not a suitable planning body. In the aspect of administrating authority, an independent inter-ministry group consists of Health Department and agencies of Ministry of Interior or Ministry of Interior alone (Social Policy Units) has high degree of agreement. The independent inter-ministry group consists of Health Department and agencies of Ministry of Interior has the highest level of importance (Q3~Q1=5~4, average = 4.31), and Ministry of Interior or Ministry of Interior (Social Policy Units) has lower level of importance (Q3~Q1=3~2, average = 2.79). [7]Main management institution of long-term care insurance In the aspect of main management institution of long-term care insurance, the entities with high degree of agreement are public agency and any legal entity such as foundations. Public agency has the greatest importance (Q3~Q1=5~4, average = 4.25). [8]Questions related to long-term care insurance benefits The following are the findings regarding insurance benefits: (1)In the aspect of beneficial party, it is highly agreed that beneficiaries are people required long-term care based on evaluation of degree of physical or mental disability (classified as mild, medium, and serious levels) regardless of age. Its level of importance is also the highest (Q3~Q1=~5, average = 4.84). (2)In the aspect of care format (institutional, community, and in-home), nursing homes, home care, day care, registered care centers, and respite care have high degree of agreement. Nursing homes have the highest importance level among them (Q3~Q1=5~5, average = 4.88). (3)In the aspect of service details, medical care service, rehabilitation service, institutional ward fees, short-term respite care, daily routine service (turning-over, bathing and so on), and transportation service have high degree of agreement. Medical care service has the highest level of importance (Q3~Q1=5~5, average = 4.65); while transportation has the lowest level of importance (Q3~Q1=4~3, average = 3.23). (4)In the aspect of benefits offering methods, combination of care service and cash payment and care service alone have high degree of agreement. Combination of care service and cash payment has highest level of importance (Q3~Q1= 5~4, average = 4.31). [9]Questions related to long-term care insurance payments Among the items in the aspect of insurance payments, the following have high degree of agreement: capitation, global budgeting, and case payment. Capitation has the highest degree of importance (Q3~Q1=5~4, average = 4.54), and case payment has lower level of importance (Q3~Q1=4~3, average = 3.13). [10]Methods of long-term care insurance fee assessment Among all methods that are most suitable for fee assessment, advanced assessment has high degree of agreement and its importance is also of the greatest (Q3~Q1=5~4, average = 4.48). [11]Recommendations The issue of long-term care will become more important as time progresses, and the timing of implementation depends on current economical situation of the country. However, an insurance system that lasts long cannot be obtained in a short period of time. As a result, it is recommended that regardless if current financial situation is difficult, related government departments should plan and solve problems of long-term care insurance as soon as possible.