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

Research on East Asian welfare states has often emphasized regime typologies while paying less attention to the political contestation shaping health policy trajectories. This theoretical/conceptual article develops a historical-institutional framework for understanding Taiwan’s health politics beyond National Health Insurance (NHI). Drawing on official policy documents, legislative materials, ministerial statements, civil society publications, and scholarly literature, the article argues that Taiwan’s health politics is organized by two durable cleavages: the tension between technocratic cost containment and electorally driven expansion, most visible in NHI financing politics, and the tension between public care provision and household-based migrant care labor, most visible in long-term care. Tracing the trajectory from NHI’s establishment in 1995 through LTC 1.0, LTC 2.0, the 2026 launch of LTC 3.0, and the 2024 to 2025 changes to migrant caregiver hiring rules, the article shows that these cleavages tend to generate asymmetric outcomes: incremental expansion, delayed fiscal adjustment, and continued reliance on stratified care labor. By linking long-term care policy to political contestation, labor regulation, and welfare governance, the article contributes to comparative debates on aging, care systems, and welfare state development in East Asia.