Yue-Chune Lee
Professor, Master Program in  Transdisciplinary long-term care and management, National Yang Ming Chiao Tung University


Owing to a lower fertility rate and an aging society, Taiwan has become one of the rapidly aging countries in the world. Since 2017, the government has promoted Long-term Care Plan 2.0, which aims to integrate long-tem1 care services to bring about better care outcomes, expand subsidies, integrate long­te1m care service centers, introduce community comprehensive care models, expand service capacity, increase service flexibility, and provide continuous and composite services as well as focus on the integration of community care, long-term care, and prevention services.

An update to the Long-term Care Plan in 2018 included a contracted system, bundle payment, and a new payment scheme. In addition to expanding reablement services and the rental of assistive devices, Long-term Care Plan 2.0 also appoints a specialized unit or case manager, designated as “Tier A”. The responsibilities of a “Tier A” case manager include providing assistance in drawing up care plans and linking care service resources according to those care plans. Long-term care payment approvals, which are based on a case-mix system (CMS), authorize ten payments in four categories at one time. In this approval process, the payment system adopts fee-for services, which include the number of days and services as well as the number of trips (i.e., transportation); care and professional services also share the payment limit. Furthermore, there are additional bonus payments for the cases that are deemed difficult and/or require special care or located in Indigenous areas or on offshore islands. .

Because the new Long-term Care 2.0 system has now been implemented for four years, there have been many studies aimed at evaluating this system; however, most have been limited to a few service units or a single county or city. Thus, utilizing the national Long-term Care 2.0 database for analysis and collecting opinions from scholars and experts are necessary to comprehensively evaluate the effectiveness of the Long-term Care Plan 2.0. Outcomes from this study can help the government to improve the Long-term Care 2.0 system. The long-term care quality monitoring system developed by the Organization for Economic Cooperation and Development (OECD) includes effectiveness, safety, person-centered care, and the integration of care services.

Our previous findings revealed that the use of care and reablement services (appropriateness) varies greatly among different characteristics of Tier A units. The rate of improper use of reablement is also high (62.82%): the rate of using reablement services in those without reablement needs is in fact higher than those who actually require reablement. Following a restructure on reablement services, the AOL, IADL, and CMS level of cases have significantly improved in terms of service effectiveness, especially in discharge planning cases. In professional and assistive service groups, the IADL, ADL, caregiver load, and CMS level of discharge planning cases were significantly better than those of cases who only used care and respite services. This effect was also higher for discharge planning cases than for non-discharge planning cases. Furthern1ore, we also found significantly different effects of different Tier A case management units and different cities on the effectiveness of long-term care services (e.g., ADLs, IADLs, caregiver load, problem behavior, and CMS level). In addition, cases that employed immigrant workers were less likely to use long term care services.

From the above results, the effectiveness of Long-Term Care 2.0 can still be improved. Results of this study, including those related to effectiveness indicators, can be used for developing rewards of fee-for performance. This study can also provide a basis for quality monitoring and management of local governments and case management units with the aim of improving the overall quality of long-term care services and coverage rates.

Therefore, the purposes of this study are as follow: (1) use focus groups based on previous research results to confirm the appropriateness of previous effectiveness indicators; (2) develop novel indicators and methods to assess the appropriateness of care plans, the efficacy of benefit and payment schemes, and the effectiveness of services; and (3) establish indicators, including evidence-based efficacy indicators, to monitor the appropriateness of Long-term Care Plan 2.0. In addition, secondary data from the long-term care database and Taiwan’s National Health Insurance database will be analyzed to better understand how different demographic characteristics and household income as well as other influencing factors (e.g., insurance premium) affect the selection of long-term care services and the utilization oJ medical services. Therefore, a transition mechanism for long-term care services and medical services can be established in order to put forward advanced suggestions for the Long-term Care Plan 2.0 and improve coverage rates.