38 PERSPECTIVES ON BUSINESS AND ECONOMICS | VOL 43 | 2025 Institute on Aging, 2023). Following major reforms in 2017, Taiwan’s long-term care strategy now operates on tax funding and emphasizes “aging in place” (Yeh, 2019, p. 1340), aiming to provide comprehensive care for those who are 65 and older or disabled with both home services and institutional care (Chen & Fu, 2020). The growing population needing these services contributes to pressure for resources and funding that may not be sustainable. As the population has aged, chronic diseases now dominate mortality tables in Taiwan. According to the Ministry of Health and Welfare, in 2023, cancerous tumors were the leading cause of death in Taiwan, followed by heart disease, pneumonia, cerebrovascular disease, and diabetes (NHI Administration, 2024). Around 25.8% of all deaths were attributed to cancer and the majority were over 55 years old. Infectious disease prevention and an aging demographic have both contributed to the shift toward chronic disease mortality. However, chronic conditions are costly and require ongoing specialized care covered by the NHI. For example, cancer treatment, dialysis, and hemophilia treatment cost 5.8–82.0 times more than medical expenses for the average person (NHI Administration, 2024). More Taiwanese now live with multiple chronic conditions into late adulthood, intensifying healthcare system dependence. Multimorbidity means living with at least two chronic conditions, such as hypertension, cardiac disease, diabetes, neurodegenerative diseases, mental health conditions, and arthritis. A study on multimorbidity trends using the NHI research database found that the prevalence rose from 20% to 30% between 2003 and 2013 (Hu et al., 2019). Multimorbidity rates are especially high in older adults: Approximately 80% of the population over 54 lives with at least one chronic condition and nearly 70% of adults over 65 have two or more (Chiu, 2022). Comorbidities have been shown to significantly add to costs, as evidenced by studies in Singapore (Picco et al., 2016), raising serious concerns about the ability of Taiwan’s health services to support the number of older adults living with multiple conditions. The strain is amplified by a larger population, which could magnify the cost implications and strain on health-care resources. Taiwan’s aging population faces additional stresses from a health-care workforce shortage, following the expansion of long-term care services to meet demands driven by the prevalence of chronic conditions. The nurse-to-patient ratio averages 1:8.6, which is higher and less favorable than the overall average of 1:7 in other developed nations (Wu et al., 2021). In the United States and Australia, the ratio is even lower, with one nurse typically caring for about four patients (Wu et al., 2021). Taiwan has approximately 8 nurses per 1000 people, compared to 9.6 in Organisation for Economic Co-operation and Development (OECD) countries, and only 2.3 practicing physicians per 1000 people versus 2.6 in high-income Asia–Pacific countries and 3.6 in OECD countries (Tsai et al., 2024). This shortage arose from the rate of increase in older adults requiring care outpacing growth in the health-care workforce. With a shortfall in medical professionals, there is potential for disparities in medical coverage, poor quality of care, and burnout among providers. Overview of the health-care system Taiwan operates a single-payer universal health-care system, wherein the government manages health-care financing under an integrated framework, providing coverage for all citizens. The NHI was implemented in 1995 and is recognized for its success in comprehensive care, universal coverage, and cost-effectiveness (Wu et al., 2010). The current system has been modified since its introduction, with a wider range of services, including inpatient care, outpatient care, preventative services, traditional Chinese medicine, prescription drugs, dental care, and elderly care, covering around 99% of the population (Gusmano, 2023). Although the Taiwanese health-care system is largely regarded as a successful example of universal health care with high satisfaction rates, modifications can ensure that the needs of the rising elderly population are met. The NHI is financed primarily through premiums paid by the insured, employers, and the government, with rates calculated based on income and occupation. To guarantee equitable access to health care, Taiwan offers premium subsidies for eligible populations. Citizens are classified into six categories, with contribution rates ranging from 0 for low-income individuals, who are fully subsidized, to 100% for the self-employed (Wu et al., 2010). On average, Taiwanese citizens pay NT$1377 (approximately US$42) per month in premiums (Hsu & Lin, 2024). Since the introduction of the NHI, the premium rate has been adjusted only twice, most recently in 2021, when it raised on average from 4.36% to 5.17% of income (NHI Administration, 2024). In 2013, the NHI underwent a revision, the Second Generation NHI, which introduced supplementary premiums on nonpayroll income, such as bonuses, rent, interest, dividends, and income from second jobs. This change aimed to create a more sustainable
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