Beyond National Health Insurance: The Contested Politics of Long-Term Care in Taiwan

Background: Research on East Asian welfare states has often emphasized regime typologies while paying less attention to the political contestation that shapes health policy trajectories. Taiwan’s health politics is organized around two institutional pillars, National Health Insurance (NHI) and long-term care (LTC), yet the political dynamics that connect financing, provision, and care labor across these domains remain undertheorized in the comparative literature.Methods: This essay develops a conceptual framework through historical-institutional analysis of policy documents, legislative records, ministerial statements, civil society publications, and the scholarly literature on East Asian welfare states. The analysis traces Taiwan’s health policy trajectory from 1995 to 2025 and identifies the cleavages structuring institutional change.Results: Both domains are structured by two enduring cleavages: between technocratic cost containment and electorally driven service expansion within the NHI, and between public care provision and household-based migrant labor within long-term care. The NHI remains broadly popular but faces recurring fiscal conflict amplified by the asymmetric electoral costs of premium increases. Long-term care has evolved from fragmented services through LTC 1.0 (2007) to LTC 2.0 (2017), while the 2024 to 2025 legal changes governing migrant caregiver hiring have deepened reliance on a parallel household-based labor regime.Conclusion: Taiwan’s health politics generates asymmetric outcomes biased toward incremental expansion, deferred fiscal adjustment, and continued reliance on stratified care labor. Four analytic gaps warrant further research: the political economy of NHI premium negotiations, comparative analysis of Taiwan’s LTC trajectory within East Asia, the intersection of immigration policy and care politics, and intersectional advocacy coalitions in health policy formation.