Healthcare in Taiwan
Encyclopedia
Healthcare in Taiwan is administrated by the Department of Health
of the Executive Yuan
. As with other developed economies
, Taiwanese people are well-nourished but face such health problems as chronic obesity
and heart disease
. In 2002 Taiwan
had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were a total 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$
752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product
(GDP) in 2001 (or US$
951 in 2009); 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2009 was 78 years.
Recent major health issues include the SARS
crisis in 2003, though the island was later declared safe by the World Health Organization
(WHO).
The current health care system
in Taiwan
, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer
compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.
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 (U.S.) 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. Although 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 $900 per person.
Department of Health (Republic of China)
Department of Health of the Republic of China is an executive agency of the Executive Yuan responsible for the administration of the public health system, affordable and universal health care, hospitals, pharmaceutical, immunisation programmes, disease prevention, supervision and coordination of...
of the Executive Yuan
Executive Yuan
The Executive Yuan is the executive branch of the government of the Republic of China , commonly known as "Taiwan".-Organization and structure:...
. As with other developed economies
Developed country
A developed country is a country that has a high level of development according to some criteria. Which criteria, and which countries are classified as being developed, is a contentious issue...
, Taiwanese people are well-nourished but face such health problems as chronic obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
and heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
. In 2002 Taiwan
Taiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population. In 2002, there were a total 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$
United States dollar
The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....
752 in 2000. Health expenditures constituted 5.8 percent of the gross domestic product
Gross domestic product
Gross domestic product refers to the market value of all final goods and services produced within a country in a given period. GDP per capita is often considered an indicator of a country's standard of living....
(GDP) in 2001 (or US$
United States dollar
The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....
951 in 2009); 64.9 percent of the expenditures were from public funds. Overall life expectancy in 2009 was 78 years.
Recent major health issues include the SARS
Severe acute respiratory syndrome
Severe Acute Respiratory Syndrome is a respiratory disease in humans which is caused by the SARS coronavirus . Between November 2002 and July 2003 an outbreak of SARS in Hong Kong nearly became a pandemic, with 8,422 cases and 916 deaths worldwide according to the WHO...
crisis in 2003, though the island was later declared safe by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO).
The current health care system
Health care system
A health care system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations....
in Taiwan
Taiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer
Single-payer health care
Single-payer health care is medical care funded from a single insurance pool, run by the state. Under a single-payer system, universal health care for an entire population can be financed from a pool to which many parties employees, employers, and the state have contributed...
compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.
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 lawMartial law
Martial law is the imposition of military rule by military authorities over designated regions on an emergency basis— only temporary—when the civilian government or civilian authorities fail to function effectively , when there are extensive riots and protests, or when the disobedience of the 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 (U.S.) 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
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
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.
| ≈ 1906 | ≈ 1998 | ≈ 2009 | |
|---|---|---|---|
| Life Expectancy | M: 39 years; F: 43 years | M: 72 years; F: 78 years | M: 75 years; F: 81 years |
| Infant Mortality | 84.1 per 1,000 live births | 6.14 per 1,000 live births | 5.35 per 1,000 live births |
| Maternal Mortality | 7.6 per 1,000 live births | 0.9 per 1,000 live births |
By 2001, 97 percent of the population were enrolled in the program. Every enrollee has a Health IC smart card
Smart card
A smart card, chip card, or integrated circuit card , is any pocket-sized card with embedded integrated circuits. A smart card or microprocessor cards contain volatile memory and microprocessor components. The card is made of plastic, generally polyvinyl chloride, but sometimes acrylonitrile...
. 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
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
alike are satisfied with NHI. However, doctors
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
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. Although 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
Equity (economics)
Equity is the concept or idea of fairness in economics, particularly as to taxation or welfare economics. More specifically it may refer to equal life chances regardless of identity, to provide all citizens with a basic minimum of income/goods/services or to increase funds and commitment for...
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.
Problems
Even with all their success in their health care system, Taiwan has suffered some misfortunes. The government is not taking in enough money to cover the services it provides, so it is borrowing money from banks. The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians and they are afraid to raise premiums because of voters. The country is slow at adopting technology except for drugs. There is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. Patients visit the doctor more frequently causing doctors to keep visits short to about 2 to 5 minutes per patient. There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events.Health information technology
Taiwan began implementing its health information network in the 1980s and continues to invest in HIT today, perfecting existing systems and incorporating new applications. Leaders in Taiwan acknowledge that HIT not only helps to provide efficient and safe medical care but will also play a significant role in sustaining the economy’s national health insurance system. Currently, all hospitals and most clinics are connected to the Bureau of National Health Insurance through (BNHI) a Virtual Private Network (VPN) for e-claim purposes. Additionally, all residents use health smart cards that contain limited EHRsSee also
- National Health Research Institutes (Taiwan)National Health Research Institutes (Taiwan)National Health Research Institutes in Zhunan, Miaoli County, is a non-profit foundation dedicated to medical research and improved Healthcare in Taiwan...
- Health care compared - tabular comparisons of health care in the US, Canada, and other countries not shown above.
External links
- "Taiwan Takes Fast Track to Universal Health Care" by T.R. Reid, All Things ConsideredAll Things ConsideredAll Things Considered is the flagship news program on the American network National Public Radio. It was the first news program on NPR, and is broadcast live worldwide through several outlets...
, April 15, 2008. - "Sick Around the World", FRONTLINE, PBS, April 15, 2008
- "Universal Health Care in Taiwan" Journalists collecting and disseminating information about the pros and cons of universal health care, April 2, 2011