37 MARTINDALE CENTER FOR THE STUDY OF PRIVATE ENTERPRISE Super-aged Taiwan: Addressing challenges to health-care sustainability Hannah Falatko Taiwan’s aging population threatens the sustainability of its universal health-care system. With a growing elderly population, chronic disease rates rise; at the same time, the number of health-care professionals has been declining. This imbalance strains the National Health Insurance, with fewer working-age people contributing to its funding. This article examines the sustainability of the health-care system, analyzing the funding structure, long-term care policies, and government initiatives that address the challenges. Introduction Due to demographic and societal shifts, Taiwan’s population has aged rapidly over recent decades. The United Nations has three classifications for populations in terms of aging: An aging society is one in which 7% or more of the population is 65 or older; an aged society has 14% or more; and a super-aged society has 20% or more (Scherbov & Sanderson, 2019). Taiwan reached aging society status in 1993, became an aged society in 2018, and is projected to become a super-aged society by 2025 (National Development Council, 2024c). What is driving the aging trend? The rapid increase in the aging population stems from persistently low fertility rates combined with longer life expectancies. In 2023, Taiwan’s births per year fell to a record low of 136,000, lowering the fertility rate to 0.865 children per woman (National Development Council, 2024a, 2024d). Taiwan has historically had among the lowest birth rates in the world—below 1.3 children per woman nearly every year since 2003. These low fertility rates reflect evolving social norms surrounding marriage and childbearing, along with economic concerns (Yee, 2024). Concurrently, life expectancy in Taiwan has increased over recent decades, with a peak of 81.11 years in 2020, followed by a slight decrease in 2021 and 2022 (a consequence of the COVID-19 pandemic). The United Nations (2024) predicts that life expectancy in Taiwan will continue to climb, reaching 81.88 years in 2030. This combination of low fertility rates and high life expectancy has resulted in a significant rise in the elderly proportion of the population. As argued in the following sections, Taiwan’s rapidly aging population creates an unsustainable imbalance: Rising chronic disease prevalence and expanded care requirements among the elderly strain a health-care system already facing workforce shortages and funding constraints, necessitating comprehensive policy reforms to preserve its successful universal health-care model. The old-age dependency ratio, which compares the share of those 65 and older to the working-aged, 15–64, demonstrates the effects of an aging population: Taiwan’s ratio is increasing. In 2023, the oldage dependency ratio stood at 26.3, meaning there are 26.3 people aged 65 or older for every 100 working-age individuals (National Development Council, 2024b). This rate has been on an upward trend and will continue to rise, reaching 30 by 2026 and 50 by 2040. The old-age dependency ratio highlights the economic burden on the working-age population, which will soon approach a crisis point and be on par with Japan, the oldest population in the world, with a ratio of 50 in 2021 (Mathieu, 2024). Implications of a super-aged population Taiwan’s transition to a super-aged population coupled with declining birth rates will result in a serious imbalance in the health-care system. There will be additional people living with multiple chronic conditions requiring long-term care, with fewer workers contributing to National Health Insurance (NHI) funding and fewer personnel to care for the elderly. The aging population, with demands for both primary and specialized services, is an urgent concern. In response, its health policy has shifted to supplemental long-term care services. Long-term care aims to deliver a variety of services to maintain quality of life and independent living for as long as possible, especially for the elderly and disabled (National doi:10.18275/pbe-v043-006
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