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Dissertation Han-Ping Huang.Pdf Technische Universität Dortmund Fakultät Erziehungswissenschaft, Psychologie und Soziologie Possibility and Problems of a cross- country Comparative Analysis of Long- term Care Needs and Systems: Germany and Taiwan in Comparison Dissertation zur Erlangung des akademischen Grades Doktor der Philosophie (Dr. phil.) vorgelegt von Han-Ping Huang, geboren am 02. April, 1978 in Tainan, Taiwan Erstgutachten: Prof. Dr. Gerhard Naegele Zweitgutachten: Prof. Dr. Monika Reichert September, 2017 Content Chapter 1. Issues Related to Long- term Care Needs………………………….…………….1 1.1 The General Situation in Germany and Taiwan……………………………………………..2 1.1.1 The Extended Life Expectancy (at Birth)………............................................................6 1.1.2 Trends in Total Fertility Rate and the Old- Age Dependency Ratio……………………9 1.1.3 Informal care force and Female Labor Force Participation Rate…………………….14 1.1.4 The Principle of Ageing in Place in Taiwan…………………………………….......17 1.2 The Predicament of Long- term Care System in Taiwan………………………………..,...19 1.3 Discussion and Conclusion………………………………………………………………...29 Chapter 2. The Measurement of Long- term Care Needs and Its Attribution…………....31 2.1 The Measurement of Long- term Care Needs with Dementia……….…………………….32 2.2 The Attributes of Long- term Care Recipients in Germany………..………………………37 2.2.1 The Proportion of Care Patterns…………………………………………………….38 2.3 The supply of Long- term Care Service in Taiwan………………………………………...39 2.3.1 The Pattern of Long- term Care Service …………………………………………...…40 2.3.2 The Attributes of Long- term Care Recipients in Taiwan……………………………..42 2.4 Discussion and Conclusion………………………………………………………………...45 Chapter 3. Social Policy as a Response to Social Risks- Long- term Care Needs………48 3.1 The Concept of Welfare State, Social Insurance and Social Security……………………...48 3.1.1 The Concept of Welfare State…………………………………………………………49 3.1.2 Germany: A Social State and Conservative Welfare Regime………………………....51 3.1.3 Traditional Confucianism Culture in Chinese Community: Taiwan…………………..60 3.1.4 The relation between Social Insurance and Social Security……..................................66 3.2 The Concept of Social Policy and its Relation to the Welfare State……….………………68 3.3 The Response of Conquering Social Risk- Cases from Germany and Taiwan…….….…...72 3.4 Discussion and Conclusion………………………………………………………………...76 Chapter 4. The Perspective of Party Politics and the Current Social Security Scheme in Taiwan……………………………………………………………..…………………………..79 4.1 The Development of Social Welfare Policy in Taiwan…………………………………….79 4.1.1 The Perspective of Party Politics……………………………………..……….............86 4.2 The Current Social Security scheme and Related Care Policies…………………….……..88 4.2.1 The Social Insurance Schemes………………………………………………..….........90 4.2.2 The Program for Social Assistance……………………………………………………91 4.2.3 The Fields of Health/ Medical Care………………………………………………….95 4.2.4 The Role of Religion…………………………………………………………………100 4.3 Discussion and Conclusion………………………...……………………………………..102 Chapter 5. The Current Long- term Care Policies in Taiwan……………………………105 5.1 Ten Year Long- term Care Program: 2007 to 2017……………………………………….105 5.1.1 The Eligibility of People and Long- term Care Service……..………………………106 5.1.2 The Integrated Care Management System…...………………………………………108 5.1.3 The Development of Caregiver in Long- term Care System…..…………………….113 5.1.4 The Purveyance of Care Service and Compensation…………………………...……115 5.1.5 The Achievement of The Ten Year Long- term Care Plan…………..…………...….117 5.2 The Long- term Care Service Act………………………………………………………...119 5.2.1 The Competent Authority for Long- term Care Service.……………………....…….122 5.2.2 A Legal Foundation for the Employment of Foreign Care Force……………………126 5.2.3 The pattern of Long- term Care Service and Its Development……………………....129 5.3 Discussion and Conclusion……………………………….………………………………131 Chapter 6. Social Insurance Approach for the Long- term Care System in Germany....134 6.1 The Social Policy and Its Principle in Germany………………………………………….134 6.2 The “Fifth Pillar” of Social Insurance System……………………………………………141 6.3The Background of introducing Long- term Care Insurance……………………………145 6.3.1 The Historical Development of Long- term Care Insurance Act…………………….148 6.4 The Overview of Germany’s Long- term Care Insurance………………………………..149 6.4.1 The Evaluation Process for classifying the Care Level……………………………...152 6.4.2 The Benefit for Long- term Care Insurance………………………………………….157 6.4.3 Management and Organization of Long- term Care Insurance……………………...166 6.4.4 General Contribution of Long- term Care Insurance…………………….…………..168 6.5 After the Reform Is Before the (Next) Reform……………………….…………………..170 6.6 Discussion and Conclusion……………………………………………………………….180 Chapter 7. A Suitable Model for Taiwan’s Long- term Care Policy- Germany’s Lessons……………………………………………………………………………………….182 7.1 A Suitable Model for Taiwan…………………..…………………………………………182 7.1.1 The Structure of Long- term Care Insurance………………………………………...183 7.1.2 The Financial Planning and the Contribution………………………………………..184 7.1.3 The Administration of Long- term Care Insurance…………………………………..187 7.1.4 Care Management and its operation…………………………………………………188 7.1.5 The Benefits for Care Receiver and the Support for Caregivers………………….....189 7.2 Conclusion………………………………………………………………………………..193 Reference…………………………………………………………………………………….194 1. Part of English and German…………………………………………………………….…195 2. Part of Chinese………………………..………………………………………………..208 Appendix: Long- term Care Service Act List of Tables Table 1.1 Age Groups as a Proportion of Total Population in Germany and Taiwan in 2008, 2020 and 2060……..……………………………………………... 4 Table 1.2 Medium Life Expectancy (at birth) in Germany and Taiwan, 2010 and 2060………………………………………………………………………... 8 Table 1.3 Healthy Life Expectancy (HALE) at Birth in Germany and Taiwan in 2012………………………………………………………………………... 9 Table 1.4 Old- Age Dependency Ratio in 2008, 2012 and 2060 in Germany and Taiwan……………………………………………………………………... 13 Table1.5 Female Labor Force Participation Rate in Germany and Taiwan, Comparable in 1989, 1994, 1999, 2004 and 2008…………………............ 16 Table 1.6 The Medical Expenditure of Citizens Aged 65 and over in the National Health Insurance (NHI)………………………………….………………... 26 Table 1.7 The Medical Expenditure of Citizens Aged 80 and over in the National Health Insurance (NHI)……………………………………………………. 27 Table 2.1 Three Degrees of Disability under the Act of Long- term Care Insurance in Germany……………………………………………………………….... 33 Table 2.2 Three Degrees of Disability under the Ten- year Long- term Care Program in Taiwan…………………………………………………………………. 34 Table 2.3 Contents of Barthel Index………………………………………………… 36 Table 2.4 Instrumental Activities of Daily Living Scale (IADL)………………….… 37 Table 2.5 The Distribution of Continuing Care Retirement Community and Long- term Care Facilities in Taiwan……………………………………… 43 Table 3.1 The Principle of Social State in Germany’s Basic Law………………….... 56 Table 3.2 Welfare Index Comparison of Germany and Taiwan……………………… 63 Table 4.1 The Main Social Policies in Taiwan (1949- to present)...………..………... 81 Table 4.2 Ten Categories regarding social policies in the Constitution and Additional Articles of the Constitution in Taiwan………………………… 83 Table 4.3 The Social Welfare Ideology of the Chinese Nationalist Party and Democratic Progressive Party in Taiwan………………………….………. 87 Table 4.4 Current Social Insurance Scheme in Taiwan…………………………..…... 92 Table 4.5 Current Care and Income- Protection Policies for the Elderly and Disability in Taiwan……………………………………………….………. 97 Table 5.1 The Definition of Eligible people in Acts for Long- term Care…….….….. 107 Table 5.2 The Statistics and Estimation of Separate Service Target………………..... 108 Table 5.3 The Process of Care Management in Long- term Care Management Center……………………………………………………………………… 109 Table 5.4 The Means- test Concept in The Ten Year Long- term Care Program…….. 116 Table 5.5 The Current Structure and Authorities of Long- term Care in Taiwan……. 120 Table 5.6 The Authorities and Sources of Law for Long- term Care system in Taiwan………………………………………………………..……………. 123 Table 5.7 Foreign residents in Taiwan from 1992 to 2009…………………………... 127 Table 6.1 Time Chart of Germany’s Main Social Policies (1839- to date)………….. 136 Table 6.2 Ageing Population in Germany, 2000- 2030……………………………..... 146 Table 6.3 Further Life Expectancy in Germany at Age 65 in 2006/ 2008 and 2060… 146 Table 6.4 Classified Three Levels for Long- term Care Need……………………….. 153 Table 6.5 The Evaluated Formula for Classifying Care Levels by the Medical Review Board………………………………………………..…………….. 155 Table 6.6 The Proportion of Cash Allowance and in- kind Outpatient Benefits, 1995- 2014………………………………………………………………… 159 Table 6.7 Entitlement to Benefits and Services for Persons Insured under the German Long- term Care Insurance Scheme at a Glance, in 2015……….. 162 Table 6.8 The Benefits of Germany’s Long- term Care Insurance Act……………..... 165 Table 6.9 The Burden of the Long- term Care Contribution…………………….…... 169 Table 6.10 The Adjustment of Benefits based on the type of care patterns and Care Levels (in comparison with 2014 and 2015)…………………….…... 172 List of Figure Figure 1.1 Population pyramid data in Germany and Taiwan, 2010, 2030 and 2050…... 5 Figure 1.2 Total fertility trends in Germany, 1950- 2060………………………………. 10 Figure 1.3 Total fertility trends in Taiwan, 1990- 2056………………………………… 11 Figure 1.4 The Development of Household Size in Taiwan, 2000- 2011………………. 23 The Proportion of the
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