Assessing Integrated Care Mechanisms in Taiwan’s Long-Term Care System

Abstract Background In response to Taiwan's rapidly aging population, the Long-Term Care Plan 2.0 (LTC 2.0) was launched in 2017 to enhance integration across long-term care services, including the establishing of Tier A care management centers. Understanding how Tier A centers perceive the level of integration, and the factors influencing it, is critical for informing the forthcoming LTC 3.0 reform in 2027. The study aimed to address the gap. Methods The study employed a cross-sectional survey design using a well-developed tool, the Taiwanese Self-Assessment for Systems Integration (TwSASI) tool. A total of 252 valid responses were collected from supervisors of Tier A agencies, drawn from a population of 631 agencies certified by Taiwan's Ministry of Health and Welfare. TwSASI measured perceived integration level across four domains: inter-entity organization and management (10 items), care coordination (11 items), resource integration (4 items), and information systems (5 items). Organizational factors, such as location were assessed as well. Multiple regression analysis was used to identify organizational factors associated with higher integration. Results The domain of care coordination (8±0.96) received the highest scores, while integrated information systems was lowest (7.14±1.43). The longer an organization has been established reported better integration across all domains (β = 0.28, p < 0.001). Formal email communication was positively associated with inter-entity coordination (β = 2.58, p < 0.001), while frequent collaboration with Tier B agencies correlated with lower information integration (β= -0.02, p < 0.001). Government-provided platforms positively influenced information system integration (β = 1.46, p = 0.01). Conclusions This study is among the first to assess factors influencing integrated care in Taiwan's long-term care system. Findings highlight that organizational experience, effective communication, and robust digital infrastructure enhance integration. Key messages • Tier A agencies in Taiwan rated care coordination was strongest domain, information system integration weakest. • Older Tier A agencies and formal email communication are linked to higher integration. Collaboration overload with Tier B agencies posed challenges.