Unmet Long-Term Care Needs and Healthcare Use in Taiwan: Evidence to Inform Taiwan's TLTCP 3.0

Abstract Background As Taiwan ages rapidly, the government implemented Ten-Year Long-Term Care Program (TLTCP) 1.0 (2007) and 2.0 (2017) to meet rising care demands. Despite these efforts, unmet long-term care (LTC) needs remain, leading to poor health outcomes and increased healthcare use. As TLTCP 3.0 is being planned, evaluating current services is essential. This study examines associations between unmet LTC needs and healthcare utilization to inform policy development. Methods We partnered with six county governments to conduct in-person, online, and phone surveys of LTC service users or their caregivers. The Long-Term Care Unmet Needs Appraisal Scale (LTC-UNAS), a validated tool using a 1-5 Likert scale, measured unmet needs across 11 types of tasks (e.g., self-care, physical health, transportation). Self-reported healthcare use (outpatient, emergency, hospitalization) over the past six months was collected. Multiple linear regression adjusted for welfare status and comorbidities. Analyses were stratified by disability level. Results Data were collected from 1,217 users and caregivers. Mean user age was 74.6 (±17.1) years; 60.1% were female. Users reported 5.68 (±9.99) outpatient visits, 0.52 (±1.35) emergency visits, and 0.54 (±2.92) hospitalizations. Most had moderate (45.6%) or mild (32.4%) disabilities. The average unmet needs score was 2.92; moderately disabled users reported the highest needs (3.00), mainly in self-care, housework, and welfare access. Unmet needs were significantly associated with more outpatient visits (b = 0.13***) and emergency use (b = 0.02***), but not hospitalizations overall. However, unmet needs predicted hospitalizations among moderately and severely disabled users. Conclusions Unmet LTC needs are linked to higher outpatient and emergency use, particularly in those with greater disability. Addressing these gaps is vital as Taiwan advances toward TLTCP 3.0 to reduce avoidable healthcare use and improve care integration. Key messages • Unmet LTC needs raise outpatient and emergency use, especially among moderately and severely disabled. • Closing these gaps is vital for reducing avoidable care and shaping TLTCP 3.0.