Social expenditure in Taiwan (China)

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Among the various categories of expenditure, education spending received the highest priority and continues to do so up to this day. Furthermore, the government was able to match its human resource development targets with the actual needs of the economy while promoting competition among individuals for educational advancement. Spending on another priority area-social security-has risen gradually with social security programs initially covering only a small targeted segment of the population and then expanding to cover a wider cross-section of the society. Meanwhile, a comprehensive National Health Insurance (NHI) was introduced only a few years ago (in 1995). The hallmark of Taiwan (China's) approach to social policy has thus been gradualism. This aspect has helped it avoid fiscal crises due to unsustainable social spending. However, democratization in recent years will likely to accelerate such spending. World Bank Institute  Copyright C 2001 The International Bank for Reconstruction and Development/The World Bank 1818 H Street, N.W. Washington, D.C. 20433, U.S.A. First Printing January 2001 The World Bank enjoys copyright under protocol 2 of the Universal Copyright Convention. This material may nonetheless be copied for research, educational, or scholarly purposes only in the member countries of The World Bank. Material in this series is subject to revision. The findings, interpretations, and conclusions expressed in this document are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or the members of its Board of Executive Directors or the countries they represent. Social Expenditure in Taiwan (China) Peter C. Y. Chow 2001. 55 pages. Stock No. 37167  Contents Foreword v The Development of Social Spending Policies in Taiwan 4 An Evaluation of the Development of Social Spending in Taiwan 36 Summary and Conclusions 40 References 41 Appendix 45 iii   Foreword This paper, entitled Social Expenditure in Taiwan (China) by Professor Peter C. Y Chow of City University of New York (CUNY), was prepared for a project on Social Development in East Asia. The project was organized by the World Bank Institute under the auspices of the Program for the Study of the Japanese Development Management Experience which is financed by the Human Resources Development Trust Fund established at the World Bank by the Government of Japan. The principal objectives of this Program are to conduct studies on the Japanese and East Asian development management experience and to disseminate the lessons of this experience to developing and transition economies. Typically, the experiences of other countries are also covered in order to ensure that these lessons are placed in the proper context. This comparative method helps identify factors that influence the effectiveness of specific institutional mechanisms, governance structures, and policy reforms in different contexts. A related and equally important objective of the Program is to promote the exchange of ideas among Japanese and non-Japanese scholars, technical experts and policy makers. The outputs of the project on Social Development in Asia include seven papers on topics such as pension systems, health insurance, education, and employment policies which are scheduled to be published in the WBI Working Paper series. In addition, a set of papers focusing on the social policy experience of Japan over the past fifty years is being processed separately as a book- length manuscript. Farrukh Iqbal, Program Director World Bank Institute v   Social Expenditures in Taiwan (China)* Peter C. Y. Chow City University of New York Department of Economics Those countries that have been most successful-including, notably, many here in East Asia-have also invested heavily in their people, have put in place the right policy fundamentals, and have not discriminated against their rural sectors. Address to the Board of Govemors Hong Kong, China by James D. Wolfensohn, President The World Bank Group September 23, 1997 The ultimate aim of economic development is to promote the well-being of people. As an economy becomes more modernized, both the demand for and supply of social expenditures increases. Hence, the growth of social expenditures in Taiwan has accelerated in accordance with economic development, social transformation, and democratization in the last three decades. In this study, "social expenditures" include education, social welfare payments (for example, social insurance for income security, employment services, social assistance, and welfare services) as well as public health and medical care. Amonig these, Taiwan has been focusing most heavily on education and income security for targeted population segments-such as retirement pensions and survivors' benefits for public service employees. Government support of education is evidenced by priority funding for education, science, and culture in government budgets as stipulated in Article 10 of the Amendments to the Constitution. Government expenditures on pensions and survivors' benefits for civil service employees, military personnel, and other insurants have been built into their respective retirement systems. By contrast, social assistance is selectively granted to the needy only. Until the proposed National Annuity System is implemented by the year 2000, Taiwan has no nationwide income security or unemployment insurance systems equivalent to those found in the United States. Therefore, Taiwan's social welfare system is far behind that of many industrialized economies. In its earlier stages of development, Taiwan's health insurance covered only government employees, military personnel, teachers and school administrative staff members, and insured laborers in a handful of occupations. The plan was gradually extended to cover farmers, fishermen, and low-income households before a comprehensive National Health Insurance (NHI) system was inaugurated in March 1995.1 However, despite the incomplete coverage of its social welfare system, Taiwan was able to achieve modest progress in social development compared with other developing economies at a similar level of Taiwan refers to Taiwan (China) throughout this paper. Prior to March 1, 1995, insured persons (including those covered by labor insurance, govemment employee plans, and related schemes) accounted for only 57.6 percent of the total population. I  2 Peter C Y Chow development. Taiwan has maintained a relatively equitable income distribution in comparison with other developed and developing economies. The ratio of income shared by the top 20 percent of households to that of the bottom 20 percent of households fluctuated between 4.17 and 5.38 during the 1980-96 period,2 and the Gini coefficient fluctuated between 0.29 and 0.32. Moreover, Taiwan has also performed relatively well based on other social indicators. Table I below compares some selected social indicators among Taiwan, other developing economies, and industrial economies. In addition to its equitable distribution of income, Taiwan has made modest progress in many other social indicators in the past three decades: life expectancy at birth increased from 62.3 in 1961 to 71.87 in 1996 for men, and from 66.76 to 77.92 for women in the same period . The percentage of school-age children enrolled in elementary schools increased from 84 percent in the 1952-53 academic year to 99.91 percent in the 1995-96 academic year, and that in junior high schools increased from 34.85 percent to 99.75 percent in the same period .The adult literacy rate increased from 74 percent to 94 percent, the number of health personnel per 10,000 persons increased from 11.37 in 1961 to 57.53 in 1996, and the number of hospital beds per 10,000 persons increased from 3.70 in 1961 to 53.39 in 1996.3 According to the criteria of the United Nations Development Programme (UNDP), Taiwan's social indicators have reached a stage of high human development similar to that found in developing economies. Other social indicators such as infant mortality and maternal mortality rates are summarized in table 2 below. For the sake of brevity, other relevant social indicators are illustrated by a series of diagrams presented in the Appendix. According to the Human Development Report by the UNDP, government expenditures on social security benefits accounted for 16.2 percent of the gross national product (GNP) in industrialized economies, but only 2.7 percent of the GNP in developing economies classified as those with high human development during the 1985-90 period.4 It was estimated that social security expenditures in Taiwan accounted for 5.87-6.81 percent of the GNP (21.2-24.6 percent of the total government budgets) in 1996.5 Therefore the share of social security expenditures in Taiwan, though far above that of developing economies classified as high human development, is still much lower than what is found in industrialized economies. An interesting question that arises is how the social security system in Taiwan-which is far less comprehensive and has a much smaller share in its total GNP than in industrial economies- contributes to social development to such an extent that it (according to comparisons of selected social 6 indicators reported in table 1) outperforms industrialized economies by UJNDP criteria. Could one generalize the Taiwan experience so as to provide some transferable lessons for other developing economies? These topics are interesting not only for academic economists but also policymakers who are mapping out development plans and strategies for developing economies. The purpose of this study is to analyze these three major categories of social expenditures-education, social welfare, and health care-in Taiwan, and to investigate how Taiwan's social expenditure policies have contributed to its social development as reflected in its social indicators, which are better than other developing economies at similar levels of development. It is expected that through this study, one could derive significant lessons and experiences from Taiwan's social expenditures and its resultant social development. 2 The ratio was higher than in the Netherlands (4.5) and in Japan (4.6), but lower than in Brazil (32.1), Hong Kong (123), Singapore (9.6), the United States (9.1), and Korea (5.7). 3. CEPD (1996). Executive Yuan. 4 From table 18 in Human Development Report 1994, United Nations Development Programme (UNDP 1994). 5 A broad definition of social security benefits in Taiwan includes social welfare, community development and environmental protection, as well as pension and survivors' benefits. The figures depend on whether or not one includes community development and environmental protection in social security expenditures. The above three categories accounted for 14.4 percent, 3.4 percent, and 6.8 percent, respectively, in net expenditures of the govemment budget in 1996, whereas net expenditures of all levels of govemment accounted for 27.7 percent of the GNP in 1996. CEPD (1998), Ministry of Finance (1995). 6 The only exception is the adult literacy rate, which is 94 percent in Taiwan but 98.3 percent in industrialized economies. With no male-female distinction, one cannot argue whether life expectancy at birth in industrialized economies is longer or shorter than that in Taiwan.  Social Expenditures in Taiwan (China) 3 Table 1. Selected Social Indicators Taiwan HHD MHD LHD ADCs IC 1996 1994 1994 1994 1994 1994 Life expectancy at birth (years) 71.87 (m)a 71.5 67.1 56.4 62.1 74.1 77.92 (f)a Infant mortality per 1,000 live 6.66 25 46 85 64 14 births Maternal mortality rate (per 7.68 119 206 753 471 31 100,000 live births) Daily calorie intake per capita 3,076 2,894 2,730 2,262 2,253 Population with access to safe 88.8 85 69 71 80 water (percent)b Adult literacy rate (percent) 94 92 80 50 64 98.3 Public expenditure on education 5.73 4.6 2.9 3.4 3.6 5.4 as percent of the GNP [Figure for 1993-94]c [7.0] Social security benefits 5.2 2.7 3.3 0.6 2.7 16.2 expenditures as percent of GDP [Figure for 1985_90]d [6.2] a. M stands for male, F stands for female, respectively. b. The time period is 1990-95 for developing economies. c. If private education expenditures are included. d. If expenditures on community development and environmental protection are included. HHD: High Human Development. MHD: Medium Human Development. LHD: Low Human Development. ADCs: All Developing Countries (Economies). IC: Industrial Countries (Econornies). Sources: Data for Taiwan, except for infant and maternal mortality rates, were derived from Taiwan Statistical Data Book, 1998 (CEPD 1998a). Data for others: Except for education and social welfare expenditure, which were derived from Human Development Report, 1994, United Nations Development Programme (UNDP 1994); all other data were denrved from Human Development Report, 1997. (UNDP 1997). Table 2. Major Social Indicators in Taiwan, 1966-96 Year A B* C D E F G H I J Male Female _ 1966 65.18 69.74 21.69 71.55 23.16 32.63 3.44 10.90 38.60 1967 65.31 69.87 22.57 62.26 19.50 33.73 3.81 10.20 39.10 1968 65.22 70.01 20.71 54.03 16.40 34.36 4.20 9.14 41.00 1969 66.34 70.89 19.14 48.88 15.30 35.38 3.57 8.85 41.60 1970 66.66 71.56 16.85 40.35 14.70 35.45 3.96 9.30 43.70 1971 67.19 72.08 15.51 39.69 16.83 35.37 15.99 12.16 41.40 1972 67.56 72.30 14.02 34.72 13.30 37.07 16.80 12.49 44.00 1973 67.57 72.48 14.08 40.33 13.80 41.53 18.26 13.14 46.30  4 Peter C. Y. Chow 1974 67.80 72.76 12.94 32.35 13.30 40.22 17.77 14.17 48.70 1975 67.27 73.42 12.57 24.75 12.90 38.56 18.85 16.47 50.30 1976 68.70 73.59 10.60 29.53 12.16 37.56 92.63 43.17 19.66 19.39 53.70 1977 68.69 73.85 11.47 29.56 11.71 39.14 93.46 44.47 22.32 20.66 57.80 1978 69.15 74.32 9.91 22.48 11.24 39.16 94.18 44.51 21.33 21.12 61.60 1979 69.36 74.48 9.55 17.28 10.74 39.21 94.60 45.27 20.78 22.66 63.80 1980 69.56 74.54 9.83 18.66 10.34 39.25 94.77 49.67 22.22 23.82 66.80 1981 69.74 74.64 8.86 19.38 9.88 38.76 95.13 52.58 24.29 25.20 69.50 1982 69.86 74.86 8.08 19.06 9.61 39.30 94.31 56.64 28.98 27.03 72.40 1983 69.90 75.08 7.64 17.01 9.15 42.12 95.43 57.62 30.65 28.10 74.50 1984 70.46 75.53 6.86 14.06 8.84 43.30 95.65 60.63 32.86 30.19 76.40 1985 70.82 75.81 6.78 9.85 8.46 43.46 95.65 62.32 38.47 34.42 77.90 1986 70.97 75.88 6.29 9.41 8.08 45.51 95.95 66.45 41.84 35.64 79.10 1987 71.09 76.31 5.08 8.94 7.79 46.54 96.09 68.43 43.88 39.27 80.20 1988 70.99 76.21 5.34 9.09 7.43 45.56 96.40 70.42 44.50 41.72 81.70 1989 71.10 76.48 5.71 12.72 7.10 46.35 96.77 70.80 43.12 42.59 82.70 1990 71.33 76.75 5.27 11.94 6.78 44.50 97.12 73.01 43.80 44.79 83.60 1991 71.83 77.15 5.05 7.78 6.41 44.39 97.97 72.93 45.14 47.15 84.20 1992 71.79 77.22 5.18 6.85 6.15 44.83 97.60 75.49 46.30 49.62 85.10 1993 71.61 77.52 4.80 8.92 5.98 44.89 98.12 77.28 47.90 52.17 86.20 1994 71.81 77.76 5.07 8.05 5.82 45.40 97.47 78.57 48.98 53.87 87.50 1995 71.85 77.74 6.43 7.59 5.58 45.34 98.36 88.84 52.62 55.37 88.00 1996 71.87 77.92 6.66 7.68 5.34 45.76 98.23 89.57 53.39 57.53 88.80 Note: A. Life expectancy at birth. B. Infant mortality rate: death rate per 1000 live births. C. Maternal mortality rate: death rate per 100,000 live births. a: Include Kinmen County and Lienkiang County-the offshore islands-since 1994. D. Illiterate rate of population aged 6 and over. E.Female labor force participation rate. F. Net enrollment rate for school-age children (6-14) in compulsory education. G. Net enrollment rate for school-age children (14-17) in senior high/vocational schools, after 1995. School-age children (12-17). H. Number of hospital beds per 10, 000 persons. I. Number of health personnel per 10, 000 persons. J. Percentage of population served by tap water. Sources: Social Indicators in Taiwan Area, DGBAS (1 996a). Ministry of Education (1998b). This paper is organized in the following order: The following section analyzes the development of policies for major social expenditures in Taiwan. Then a section is devoted to analyses and evaluations of Taiwan's experiences in its development of social spending. The final section deals with lessons of the "Taiwan experience" that are transferable to other developing economies. The Development of Social Spending Policies in Taiwan Social expenditures and economic development have interacted with each other in many developing economies, including Taiwan. First of all, educational achievement and economic development have a  Social Expenditures in Taiwan (China) 5 reciprocal cause-and-effect relationship in the development process. The emphasis of education in Taiwan has provided the nation with the necessary labor force for its economic development, which has in turn enabled both the government and its people to be able to afford higher-quality education. Second, the pursuit of economic growth with equity in Taiwan, as epitomized in the preface of its Constitution, mandated the government to expand social welfare programs after more than three decades of development. As a result, social development and political stability were enhanced, which in turn helped economic development. Taiwan's economic development is well documented (Galenson 1979; Kuo, Ranis, and Fei 1981; Tsiang 1984), but the improvement of its social welfare with relatively low social spending is rarely known. It has been argued that Taiwan had been following a similar trajectory to that of Japan in its postwar economic development ["wilci geese flying pattern" a la Akamatsu (1962), and Kojima (1989)]. Interestingly enough, social developments in the two economies exhibit many similarities: Both economies have relatively low shares of social welfare expenditures in their respective GNPs, yet both have achieved relatively high levels of social development. Moreover, the role of the family in both economies has been a very important function in education, healith care, and social welfare. But differing from Japan, Taiwan has had a heavy burden of national defense in its government budget. In the 1950s and 1960s, national defense usually accounted for more than 40 percent of the government budget. As a result, social expenditures accounted for less than 10 percent during this period. Moreover, the distribution of social welfare expenditures was concentrated in a small targeted segment of the population. Until the early 1990s, a great majority of senior citizens had to rely on private sources such as personal savings and family support for living allowances, health care, and extended personal care. Relatively speaking, educational expenditures had larger shares than that of social expenditures even though the latter could have provided the authoritarian government with more effective control for sociopolitical stability, as occurred in Singapore.7 In the 1950s and 1960s when national defense dominated government budgets, educational expenditujres still increased steadily, both in dollar amount and percentage share. This phenomenon could be explained by a multifaceted rationale. First, Taiwan's initial equitable income distribution (owing to successful land reform in the 1950s) had reduced the demand for social welfare. Second, education was considered an investment that would complement economic development in Taiwan. The expansion of education (which would provide greater social equity and employment opportunities) could enhance the earned incomes for the working class and possibly reduce the demand for social welfare. Third, the prolonged period of authoritarian regime from 1947 to 1987 in Taiwan had repressed the demand for an institutionalized social welfare system. Finally, the traditional family system, before it was eroded by industrialization and urbanization, had played an important role in providing social welfare, which is generally run by the public sector in many industrialized economies. Prior to the 1980s, social secunrty programs for income maintenance in Taiwan covered only a small segment of the targeted population. Government provisions of pensions and survivors' benefits were limited only to retired government employees, military personnel, private school teachers, and a small segment of insured labor. But, after more than three decades of economic development, Taiwan was able to expand those programs to cover more and more disadvantaged groups. Examples of such coverage are the provision of a monthly living allowance for aged farmers and low-income senior citizens. Moreover, as democratization gained momentum after the lifting of Martial Law in 1987,' many social welfare programs were speeded up by partisan competition for voter support during the periodic elections.9 As a The degree of urbanization in Taiwan is far less than that of Singapore, which is mainly a city-state. In general, demand for social welfare, especially public housing, increases as an economy becomes more urbanized. This is another rationale for explaining different policy choices of social spending between education and social welfare in Singapore and Taiwan. After Martial Law was lifted in 1987, constitutional rights and civil liberties such as the freedom of the press, freedom of assembly, and organizing opposition parties were restorecl, and the due process of the periodic election of legislative bodies at the central govemment level resumed. Expansions of social welfare programs such as liberalizing the living allowances for elderly people became party platforms and campaign slogans during periodic elections in the 1990s. The interactions of various elections held at the four levels of govemment had shortened the election cycles in Taiwan. In fact, an election was held almost every year between 1989 and 1997.  6 Peter C Y. Chow result, piecemeal social welfare programs, funded or unfunded, have proliferated rapidly since the late 1980s. A major task under way is to integrate all existing programs into a universal National Annuity System by the year 2000. Health insurance initially covered government employees, military personnel, school teachers, and a small segment of insured laborers only, but the coverage gradually expanded to more and more groups such as farmers and fishertnen. Moreover, the coverage also extended to the spouses and children of the insured in each scheme. In general, the government subsidized insurance premiums for various insured groups and compensated for the operating deficits of various insurance programs through general tax revenues. Eventually the comprehensive NHI, which integrated all existing health insurance programs into a universal one, was implemented in March 1995. From the overview of developing social expenditure policy in Taiwan, one could argue that education was considered an ingredient for economic development, whereas social welfare was more or less a residual, or by-product of modernization. The expansion of social expenditures in Taiwan was a direct result of economic development, social transformation, and democratization. Taiwan's social development in the postwar era went through an evolutionary process, under which the family played an important, but declining role in providing social welfare for its immediate and extended members. In this role, the family shares expenditures for informal and auxiliary education, provides for health care expenses and care- giving for family members, and supports the living allowances for elderly parents. Family expenditures on education, health care, care-giving, and old-age income maintenance probably are more cost-effective than public spending, but are hard to quantify for policy assessments. Education as an Investment in Human Capital In development literature, it is said that capital can be borrowed, technology can be transferred from abroad, but human capital has to be nurtured indigenously within a developing country. Taiwan, as one of the late industrializing economies, is no exception. Hence, the government placed a great emphasis on education, starting with the pyramid structure of the school system. A PROFILE OF THE EDUCATION SYSTEM IN TAIWAN. A bird's eye view of the educational system in Taiwan is illustrated in figure 1. The length of education varies from person to person. Normally it takes 16 to 18 years for a child to move from kindergarten to the completion of a college education. The preschool education usually starts with nursery school or kindergarten at age 4 or 5, depending on the individual. A formal education system of 6-3-3 (six years of elementary education, three years of junior and senior high school, respectively), was in effect until 1969, when the nine-year "fundamental compulsory education" system was implemented. After that level, there are two types of three-year secondary education-senior high schools and senior vocational schools. Both require students to pass an entrance exam. The pass rate for senior high school students was about 24-27 percent in recent years. Those who fail the entrance exams for senior high school usually go to vocational schools. For school-age children, nearly 100 percent enroll in elementary schools, and nearly 99.8 percent enroll in junior high schools. Moreover, there is no gender gap on educational opportunity. At the "fundamental compulsory education" level, there is no significant difference in enrollment rates between male and female students . For secondary and higher education, female students seem to do better in moving up the educational ladder. In the 1996-97 school year, 92.9 percent of female and 88.6 percent of male graduates from junior high school went to vocational and senior high schools. Moreover, 62.7 percent of female and 55.3 percent of male graduates from high schools went to college in the same school year.  SUPPLEMENTARY EDUCATION Open Supp. jr. SUPP. SR. Supp. jr. SUPP. ELEM. SCH. university college Sec. Sch. thgh c Z SPECIAL EDUCATION Senior high Junior ELEMENTARY KINDER- (vocational) high GARTEN TECH. and JR. COLL> NINE-YEAR COMPULSORY PRE- EDUCATION EDUCATION SCHOOL ED. Working JR. COLLEGE experience (5 years) u A. \Junior~~~~~~~~~~~ora S , |(2 years) 0~~~~~~~~~~~~~ r . l X