Practical Approaches to Advanced

Experiences in Long-Term Care Insurance

Prof. Shyh-Dye Lee, M.D., M.P.H.

(.)

()

(OTC)

(ICD)-(ICF)

..

(1)(2)(3)(4)(5)(6).

Cornerstones of LTC(generalized)

(summarized)

........

(International Workshop of Long-Term Care for the Elderly at the Turn of New CenturyAn International Experience, 2000)

(IdeologyPhilosophyConcept)

(Operating Model) (?)

(System, Scheme)()

(Care or Service Delivery & Practice)()

Its Essence, Nature, Definition, Service ScopeContent, Characteristics, , Uniqueness, Implication, Situation, Status; Coverage & Appliance, Need Assessment, Service Provision, Finance Arrangement, Reimbursement & Payment, Organization and Care Delivery SystemScheme, CareCase Management, and the Scenario of Care Issues, Conflict, Perspective, FutureVision.

(Necessary Hierarchy Organization (Public & Private Sectors); Operating Mechanism, Platform, Tasks, Plans, Actions; Review & Establishment of Regulation, Standard, Criterion, Ratio, Assessment or Appraisal, Certified or Qualified, Procedure and Requirement) .

Its Knowledge, Skill, Delivery, Appliance, Outreaching, Care Plan, Creativity, Innovative, ..for CareService doing or working on;

..

(WHO,

OECD)

()

()

? ?

85-90% 10-15%

(Fries, J Royal Soc Med, 1996)

5~7 even 7~9 DALYs or Mortality with Disability ?care in need care .? Even 8-10+ years ?

(WHO, 1990~2009)

17%29%

51%

69%

0%10%20%30%40%50%60%70%80%90%

100%

0-17 18-44 45-64 65+

Age

Source:Hoffman, Catherine, and Rice, Dorothy P. Estimates based on the 1987 National Medical Expenditure Survey. University of California, San Francisco Institute for Health & Aging, 1995.

1.55

2.65

1.58

2.68

1.53

2.43

Independent Years for each stratum of the elderly on average

84.3-7.1=77.2 77.6-5.7=71.9

Country Rank Total Male Female DALYs

Japan 1 75.0 72.3 77.7 -7~-8San Marino 2 73.4 70.9 75.9Sweden 3 73.3 71.9 74.8Spain 8 72.6 69.9 75.3

Australia 8 72.6 70.9 74.3Singapore 25 70.1 68.8 71.3

USA 29 69.3 67.2 71.3 -8~-9Taiwan 31 69.1 67.1 71.5 -7.3(-8.8-10.6?S. Korea 34 67.8 64.8 70.8China 56 64.1 63.1 65.2 -8~-9

Sierra Leone 193 28.6 27.2 29.9. .. . . .

Health Adjusted Life Expectancy (HALE)WHO, 2004 and .

Health and Long-Term Care Expenditures in GDP %

OECD Economics Department working papers no.477(2006) Projecting OECD Health and Long-Term Care Expenditures: What are the main drivers?

GDP( )

()

GDP(%)

GDP( )

()

GDP

(%)

33,874 4,358 12.9 18,607 1,505 8.1 22,691 2,125 9.4 24,643 2,014 8.2 28,140 2,612 9.3 13,342 983 7.4 26,440 2,463 9.3 26,600 2,379 7.3 25,887 2,259 8.7 22,702 1,547 6.8 24,873 2,180 8.8 22,689 1,569 6.9 26,350 2,287 8.7 8,655 535 6.2 27,069 2,275 8.4 41,646 2,543 6.1 23,262 1,905 8.2 13,114 743 5.5

16,059 868 5.4

2000

:

(

)

.

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

Year

100Mio Yen

Introduced LTCI()

(1999, /)

()

( )

()

( )

65-69 30,144 7,023 37,168 1,063 865 19 39,115

70-74 39,695 8,021 47,716 1,041 909 28 49,693

75-79 47,470 8,263 55,733 868 847 46 57,494

80-84 53,032 7,932 60,963 623 716 79 62,382

85-89 58,485 6,973 65,458 429 585 118 66,589

90-94 50,993 4,381 55,373 151 308 115 55,946

95-99 55,044 3,391 58,436 145 216 171 58,968

100 55,785 4,275 60,060 1,234 115 42 61,451

101-104 49,752 4,010 53,762 307 90 38 54,197

105-109 102,317 3,311 105,628 3,907 121 - 109,655

110-114 103,608 10,243 113,851 12,623 876 378 127,727

115-119 212,279 89,866 302,145 159,254 2,460 - 463,858

49,200

9,759 3,580 13,339 1,170 647 9 15,166

Health Care & Long-Term Care Expenditures in % of GDP

(2005)

(%) (%)

7.8 1.0

6.0 0.9

5.1 0.5

3.0 0.3

OECD % ?

5.75.13

1.10.5~

OECD Economics Department working papers no.477(2006) Projecting OECD Health and Long-Term Care Expenditures: What are the main drivers?

LTC

()

NPO, NGO (LTC)

()..

(1)?(1950s)(2)(1967) (3)(1995)

(1)(Milestone)

.1922(11)1932( 7)1941(16) 1942(17) 1945(20)

1958(33)1959(34)1961(36)

1963(38)

..

7065()

(-National Pension Law)

(2)(Milestone)

196519661969

1972~1973

1973

1980

1988

(10,000)

(20,000)

70

1983

1980

()

(careworkers)

(3)(Milestone)

1982-1983

~1984

1989

1989-19901991~

40-70 6040

~~..

Gold Plan(10-Year Strategy to Promote Health and Welfare for the Aged10

(4)(Milestone)

1992~

1993~1994~1994 41994 91994 12

1995 2

70

New Gold Plan(:: 5:4:15:3:2)

(5)(Milestone)

1995 71996 4

1996 111997 122000(12)

2000 4 2001 1

2000The Gold Plan 21st Century

(?)

/

(6)(Milestone)

2003 7

20041200452005

2006(18)

2007

(-2.3%)

2015()()

()

21

(-0.5%)()

()

(7)(Milestone)

2008

2009

...2015(26)

(compliance)

(+3.0%)()

+(14)(

..)

.

(?)(

) )

()(()

..- .( )

(.)(

)(

)()(?) (.)

1990

National Health Service Community Care Act

16()(

)( )()(ALS)( )

(

)

()()()

(COPD)

(2008)

(MDS-InterRAI)MDS/

/(functional)(medical) (psychosocial)(cognitive status) (multi-dimensional)

MDSMDS-AC, MDS-AL, MDS-CA, MDS- CHA, MDS-CMH, MDS-ESP, MDS-HC, MDS-ID, MDS-IS, MDS-MH, MDS-LTCF(MDS-NH), MDS-PAC, MDS-PC, MDS-PDMDS-PWD,

(Medicare)(Medicaid)

* MDS-AL (assisted living); MDS-CA (content assessment); MDS-CHA (community health assessment); MDS-CMH (community mental health); MDS-ESP (emergency screening for psychiatry), MDS-PC (palliative care), MDS-PDMDS-PWD (persons with disabilities), MDS-ID (intellectual disabilities), MDS-IS (integrated suite), ..

1995

/

37

()1.()2.()3.()4.()5.(

)6.(

)7.()8.14(12) 9.(

) 10.(

?).(2006)

(...)

1.2.3.4.5.

+

6.(14)(2009)

79

(9) (7)16

11

1.(18)

2.(16)

3.(21)

..(2009)

1

1

2

3

4

5

3074

(

)(

)

2 1

1-21~5

()

12

() (?)(1)25

32(2)32 50

(1~5)

1 3250

2 5070

3 7090

4 90110

5 110

(

)

(2006)

(Volksversicherung)

ADLIADL

ADLIADL

ADLIADL

2ADL

IADL

ADLIADL

ADLIADL90 ADL

45

2ADL

IADL

ADLIADL

ADLIADL3 ADL 2

2ADL

IADL

ADLIADL

ADLIADL5 ADL 4

ADLsIADLsADLs

IADLs

(2005), p.55

AWBZ

(WHO)

(International Classification of Functioning, Disability and Health, ICF)

http://www.who.int/classifications/icfbrowser/Defau lt.aspx

http://www.who.int/classifications/icfbrowser/Default.aspxhttp://www.who.int/classifications/icfbrowser/Default.aspx

49

Level 1 (> 95)ADL

Level 2 (75~95)

Level 3 (55~75)

(CRI) ADL, IADL, Rehabilitation Training, Problem Behavior & Medical Care

()

Part A-Care NeedDemand(Clinical Approaches, may be with Core-Set)

Part B ICF, PALS, HART , , TAI, MDS

(Categories & Levels of NeedDemand)

Part C Resource Consumption

Utilization Grouping & Others

Part D-Current StatusReview

()

(

)

(129)(38) (2235) (41152) (292295313)(473) (923)

(IIV)

2,9113,2934,0904,330 +13% + 24% + 5.9%

2.3% 2.4%

+3.0%

(2006-2008)SES

I() 0.50II(80) 0.50III(80) 0.75IV() 1.00()V(200) 1.25VI(200) 1.50

(50,000)

What are the Care Need Levels Required?

Level 5Level 5

Level 4Level 4

Level 3Level 3

Level 2Level 2

Care neededLevel 1

Care neededLevel 1

Care Need Levels

Support needed 1, 2

up to.. 165,800 yen per month

up to.. 194,800 yen per month

up to.. 267,500 yen per month

up to. 306,000 yen per month

up to 358,300 yen per month

up to .. 49,700 yen per month

up to .. 104,000 yen per month

Fee cap per service

, , 2009 1 Dollar (US)= 108 yen x10~11.05

10, 10.35, 10.42, 10.70, 11.05.

.

x 10~11.05 10 10.35 10.42 10.70

11.05.

x 10~10.68 10 10.23 10.27

10.45 10.68.

x 10~10.72 10 10.18 10.36 10.60 10.72.

( 2009)

(ADLs)

1~5

1.-(13) 2.-(3) 3.-(3).

12

1.-(13) 2.-(2).

(30)

5

10

()

( )

(- ) (?)

()

(RN)

(LPN)

(PT)

(OT)

(social worker)

(care worker)

.

()

(2008 )

7

69

44 5

1

(care worker) :

1~5

1.-(13) 2.-(3) 3.-(3)

12

1.-(13) 2.-(2)

(30)

(1)10(2015)

..

(2)

(unit care)

10

(group home)

5-9

(3)()

unit care

2002

(4)

.

()()(

())()

( (fairness)(justice)(equity) (altruism).

() (Rate, Density, Cumulative Risk, Probability Odds, Hazard Function.)

ADLsIADLs (

.)()

()

( )

() !

AADLs & AIADLs(

.)

esp. Mental IllnessMental RetardationRelated ConditionVentilator Care, .AssessmentAssessmentAppraisal, Appraisal, Ascertaining, Judgment, RatingAscertaining, Judgment, Rating

RankingRanking, , QQualificationualification and and CodingCoding....()()() ?

What are your measures just for these parameters ?

IncidencePrevalence Rate (r)Density (PY); Cumulative Probability (Risk) (pi )Probability Odds Hazards Function (St)

Cascading of Policy, StrategiesTactics, Execution

Policy Master Plans, Guidelines, Outlined, Directed, Making & Judgments, Memorandum (?), Decision making Strategies/Tactics;Plans, Programmes, Scheme;Hierarchy Systems, Supplementary Systems, Web/Network , Execution Validating, Service, Delivery,

Development & Progress for Long-Term Care

Development & Progress for Long-Term Care

()()

10222 ..

Age in place ?

21 (28 37 2575 )

..

Practical Approaches to Advanced Experiences in Long-Term Care InsuranceCornerstones of LTC 5 6 9 10Health Adjusted Life Expectancy (HALE)WHO, 2004 and .Health and Long-Term Care Expenditures in GDP % (1999, /) 18 19().. (1)(2)(3)(4)(5)(6)(7)(?) 291990National Health Service Community Care Act 32 3316(MDS-InterRAI) 38 39 42 43 44 45AWBZ 50 51(CRI)ADL, IADL, Rehabilitation Training, Problem Behavior & Medical Care ()()(IIV)(2006-2008) 561~51.-(13) 2.-(3) 3.-(3). 12 1.-(13) 2.-(2). ()1~51.-(13) 2.-(3) 3.-(3) 12 1.-(13) 2.-(2) (1)(2)(3)(4) 71 73()(Rate, Density, Cumulative Risk, Probability Odds, Hazard Function.) 75Cascading ofPolicy, StrategiesTactics, ExecutionDevelopment & Progress for Long-Term CareDevelopment & Progress for Long-Term Care10222 80