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Alan Stolier, MD/

HEALTHCARE AROUND THE WORLD PART 7: TAIWAN

HEALTHCARE SYSTEMS AROUND THE WORLD   PART 8: TAIWAN

The modern history of the island of Taiwan began in 1949, losing to Mao Tse-tung in a long civil war. By the 1990s, Taiwan had built bullet trains, state-of-the-art universities and developed a thriving digital industry. What it did not have was a good healthcare system. Though there were insurance plans for military, government and large corporate employees, 60% had no coverage whatsoever.

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What happened next doesn’t happen in America. For years the healthcare argument in Taiwan followed the usual liberal-conservative line, with liberals favoring a universal system and the conservatives backing the status quo. Without warning, the conservative party changed its tack and began to support a universal healthcare system. As a result, in 1994 the parliament created a National Health Insurance system guaranteeing coverage for all residents. Taiwan’s conservative President, Lee Teng-hui energetically supported the plan and in 1996 was able to win re-election.

The final plan took years of planning. Before finalizing a final plan, the Taiwanese spent time a good deal of time studying healthcare plans in other countries. They wanted to follow the tracks of industrialized countries that had already developed a successful healthcare system. To do so, they hired Professor William Hsiao, a Chinese health care economist at the Harvard School of Public Health. His famous textbook, Getting Health Reform Right, is required reading for those officials trying to repair their healthcare systems. They did not see America’s system as a system, but a market. People purchase what money can buy with many left out.

Ultimately, they decided on a model with private providers and an insurance system to pay the bills. It could have been a system based on that found in Germany or Japan. Hsiao, however, did not favor a system with so many different funds or insurance companies to pay the bills. Thus, Taiwan built a system using private doctors and hospitals with a government-run insurance. It was substantially a Canadian model. The difference is that in Taiwan, the system is not funded through general taxation as in Canada. It is funded by a premium. Both employers and employees share the cost of the premium. Participation in the system is mandatory for all. Premiums are withheld from pay and go to the government. There are subsidies for low income and disadvantaged populations. There are co-pays for most services and public assistance for those who cannot afford to pay.

As in France and Germany, every Taiwanese citizen has an NHI IC card (integrated circuit card, a smart card). A person uses the card for identification. The card stores a brief medical history. Physicians, hospitals, and labs also use the card to bill the national insurer. the patient brings the card each time he or she uses medical services. Medical providers then claim charges from the government. The government rapidly processes claims in contrast to the U.S

NHI IC CARD

There are short waiting times to see a physician and short times to schedule elective surgery. The GPs do not serve as gatekeepers. One consequence of easy access to specialists is that there is no check on whether Taiwanese use specialties appropriately. The government has recognized this problem and is instituting programs to redress it.

Taiwan, like other countries, is suffering from lack of funds for their healthcare system. As elsewhere, this is likely due to new pharmaceutical agents and new technologies. Premiums are not enough to cover all expenses and government supplements are necessary to make ends meet. And yet administrative costs account for only 2% of expenditures, about the same as for U.S. Medicare. As noted before, national health spending is about 6% of the GDP. This number is likely to rise in the future. Nonetheless, the Taiwanese are prodigious users of health services and though weaknesses exist in the system, future tweaks are likely to improve a system where all residents receive care and health statistics are excellent.

Next Part: Switzerland

Link to Part 1: HEALTHCARE AROUND THE WORLD

Link to Part 2: HEALTHCARE AROUND THE WORLD: PART 2 HEALTHCARE MODELS

Link to Part 3: HEALTHCARE AROUND THE WORLD: PART 3 FRANCE

Link to Part 4: HEALTHCARE AROUND THE WORLD: PART 4 GERMANY

Link to Part 5: HEALTHCARE AROUND THE WORLD: PART 5 JAPAN

Link to Part 6: HEALTHCARE AROUND THE WORLD: PART 6 UNITED KINGDOM

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