Forging Sustainable Health and Long-Term Care Systems: The Role of Solidarity Restricted; Files Only
Yeh, Ming-Jui (Spring 2019)
Abstract
Publicly-funded health and long-term care (LTC) systems have been under tremendous pressure to reform due to the increasing financial burdens derived from population aging, a stagnant economy, and the public’s high expectations regarding advancing new technologies, medications, and quality care. Besides the institutional approach, another aspect of reform – that is, the solidarity shared by people in the health and LTC sectors – is also worth consideration. This dissertation aims to analyze the relationship between this solidarity and the development and sustainability of health and LTC systems. In the first chapter, the boundary problem and the related sustainability issue of the National Health Insurance system in Taiwan is used as a case to develop two possible ethical origins of solidarity: civic nationalism and ethos of common life. It is argued that ethos of common life is the more plausible alternative. The second chapter, using cross-sectional survey data, empirically examines the relationship between solidarity and Taiwanese people’s support toward the health system. Adopting a comparative perspective, the third chapter focuses on the actual practice of solidarity – the scope of community, the scope of interdependence, and the costs of joint action – in health and LTC sectors in four East Asian countries: Japan, Korea, Taiwan, and Singapore. The differing solidarity reflects path dependency as well as historical legacies and policy diffusion between the health and LTC sectors in these countries. Centralization of governance is a prevailing feature in East Asia, allowing solidarity-based health systems to be established without the citizenry actually having any sense of solidarity in health care to demand that the government take action. Solidarity is a concept of which we should remain continually aware, if the arrangements in health and LTC in East Asia are to be made more broadly sustainable.
Table of Contents
INTRODUCTION.. 1
Solidarity and Public Policy. 2
The Case Study Method. 3
Research Questions. 3
Figure 1. The mutually reinforcing relationship between solidarity and policy. 5
CHAPTER 1: THE BOUNDARY PROBLEM AND THE ETHICAL ORIGINS OF HEALTH SECTOR SOLIDARITY IN TAIWAN.. 6
1.1 Background. 6
1.2 Solidarity and Stability of Health Systems. 8
1.3 The Boundary Problem of Solidarity in Taiwan’s NHI 15
1.4 Two Possible Ethical Origins of Health Sector Solidarity. 18
1.5 Discussion. 25
Table 1. The historical periods and major political events in Taiwan. 27
Table 2. Recent Debates about the Insurance Status of Populations at the Margin. 28
CHAPTER 2: SOLIDARITY AND PUBLIC ATTITUDE TOWARD THE HEALTH SYSTEM IN TAIWAN.. 31
2.1 Background. 31
2.2 Conceptual Framework. 31
2.3 Hypotheses. 33
2.4 Materials. 34
2.5 Methods. 35
2.6 Results. 37
2.7 Discussion. 38
Figure 1. The Conceptual Framework. 42
Table 1. The basic characteristics of people with and without solidarity. 43
Table 2. The results of Chi-square tests of the difference between solidarity and the willingness to pay more to support better healthcare quality of the publicly-funded health system.. 44
Table 3. The results of Chi-square tests of the difference between solidarity and supportive attitude toward the government’s role in healthcare provision. 45
Table 4. The results of stratified analysis of the relationship between solidarity and supportive attitude toward the health system.. 46
CHAPTER 3: HEALTH AND LONG-TERM CARE SECTOR SOLIDARITY IN FOUR EAST ASIAN COUNTRIES. 48
3.1 Background. 48
3.2 Rationale for Case Selection. 50
3.3 Conceptual Framework. 51
3.4 Materials. 54
3.5 Methods. 54
3.6 Results. 56
3.7 Discussion: Comparing Actual Practices of Solidarity in Health and Long-term Care. 66
Table 1. Population aging in the four East Asian countries. 78
Table 2. The three components of solidarity. 79
Table 3. Summary of the actual practices of solidarity in health and LTC sector in four East Asian countries 80
Appendix: Materials included for analysis. 87
CONCLUSION.. 90
REFERENCES. 92
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