Health in Taiwan - Health Care Reform

Health Care Reform

Taiwan started its health reform in the 1980s after experiencing two decades of economic growth. In 1987, the government did away with the martial law which mobilized the governmental departments. The government set up a planning commission and looked abroad to study other countries’ health care systems. Taiwan looked at more than ten countries and combined their best qualities to form their own unique system. In 1995, Taiwan formed the National Health Insurance (NHI) model. In a 2009 interview, Dr. Michael Chen, Vice President and CFO of Taiwan's National Health Insurance Bureau explained that one of the models investigated was the United States and that fundamentally, NHI "is modeled after Medicare . And there are so many similarities – other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance." NHI delivers universal coverage offered by a government-run insurer. The working population pays premiums split with their employers, others pay a flat rate with government help and the poor or veterans are fully subsidized. Taiwan’s citizens no longer have to worry about going bankrupt due to medical bills.

Under this model, citizens have free range to choose hospitals and physicians without using a gatekeeper and do not have to worry about waiting lists. NHI offers a comprehensive benefit package that covers preventive medical services, prescription drugs, dental services, Chinese medicine, home nurse visits and many more. Working people do not have to worry about losing their jobs or changing jobs because they will not lose their insurance. Since NHI, the previously uninsured have increased their usage of medical services. Most preventive services are free such as annual checkups and maternal and child care. Regular office visits have co-payments as low as US $5 per visit. Co-payments are fixed and unvaried by the person’s income.

By 2001, 97 percent of the population were enrolled in the program. Every enrollee has a Health IC smart card. This credit-card-size card only contains 32 kilobytes of memory that includes provider and patient profiles to identify and reduce insurance fraud, overcharges, duplication of services and tests. The physician puts the card into a reader and the patient’s medical history and prescriptions come up on a computer screen. The insurer is billed the medical bill and it is automatically paid. Taiwan’s single-payer insurer monitors standards, usage and quality of treatment for diagnosis by requiring the providers to submit a full report every 24 hours. This improves quality of treatment and limits physicians from over prescribing medications as well as keeps patients from abusing the system.

Patients and doctors alike are satisfied with NHI. However, doctors have been more dissatisfied because fee premiums are controlled by the system as well as selection of services provided under the system. Also, doctors could be heavily penalized for a wide variety of reasons such as seeing too many patients or offering too much services even if patients and services were valid. Even so, patients' satisfaction has been in the 70 percent range. This system has led to protests by health care providers. At the beginning of 2006, satisfaction decreased to the mid-60 percent range because the program needed more money to cover its services. Since then, satisfaction has gone back to the 70 percent range. Enrollees are satisfied with more equal access to health care, have greater financial risk protection and have equity in health care financing.

Taiwan has the lowest administration cost in the world of 2 percent. Before NHI, Taiwan spent 4.7 to 4.8 percent on health care. A year after NHI, it increased spending to 5.39 percent. Prior to NHI, the average annual rate of increase every year was around 13 percent. Now, the annual rate of increase is around 5 percent. Taiwan spends a little over 6 percent in GDP and less than US $900 per person.