Thursday, January 17 2019 | ASIA TODAY INTERNATIONAL - Reporting the Business that Matters in Asia
Taiwan's model for universal health cover
TAIWAN’s universal health system offers a model for the world, but Taiwan continues to be denied even observer status to the World Health Assembly, where it could help to realise the World Health Organisation’s vision of a seamless global disease prevention network . . .
TAIPEI - The World Health Organisation has for years urged Member States to take action to achieve universal health coverage by 2030. Although not a WHO member, Taiwan has offered universal health coverage to its 23 million citizens since 1995.
Taiwan launched its National Health Insurance (NHI) initiative by integrating medical programmes from existing insurance systems for labourers, farmers, and Government employees, covering half the population.
This has since been expanded to provide equal coverage to all citizens from birth, regardless of age, financial status or employment status. All foreigners who legally work or reside in Taiwan are afforded the same coverage.
The NHI is a public programme run by the Government based on a single-payer model.
Life expectancy in Taiwan has subsequently increased to levels seen in key OECD countries, with women living on average to 83.4 years old, and men to 76.8.
Yet healthcare costs are far lower in Taiwan than in most highly-developed countries in Europe and North America, at US$1,430 per capita per year, representing just 6.3% of GDP in 2016. Administrative costs run at less than 1% of the total and public satisfaction remains high, (85.8% in 2017).
Taiwan’s health system has undergone several reforms over the last 20-plus years to ensure its sustainability given shifts in the socio-economic landscape.
Implementing a Global Budget Payment on top of Fee-For-Service reimbursement method has effectively reduced annual medical expenditure growth from 12% to 5% since 2003. The way in which premiums are collected has also changed from being purely payroll-based to including supplementary premiums based on capital gains. This has created a surplus into the National Health Insurance Fund.
In addition, the NHI’s information system has migrated to the cloud, making it much easier for hospitals, clinics, and doctors to access medical information.
We encourage hospitals to upload computed tomography (CT) and magnetic resonance imaging (MRI) scans so they can be retrieved for follow-up consultations. A personalised cloud-based service known as My Health Bank enables patients to check their medical records at any time.
The Government has adopted a wide range of measures to reduce health inequalities affecting disadvantaged groups. We have premium subsidies for low-income and near-poor households, as well as the unemployed.
We have also improved the provision of services in areas with limited healthcare resources, and implemented an Integrated Delivery System (IDS) in remote areas to strengthen medical capacities and quality. Subsidies on preventive healthcare services have been increased for indigenous populations.
In a globalised world, it is impossible for countries to overcome all healthcare challenges on their own.
It is only through interdisciplinary and international co-operation that we can build a global health system that consistently and cost-effectively meets the healthcare needs of the world’s citizens, and bring to fruition the WHO’s ultimate goal of health for all.
Taiwan has a great deal of experience in building and maintaining a universal health insurance system, from service provider management to financing and coping with socio-economic change.
More to the point, we believe that Taiwan’s healthcare system can serve as a model for other countries.
Taiwan has a constructive role to play in creating a robust global health network, and the best way to share our experience with other countries is through participation in the World Health Assembly and the WHO.
It is regrettable that political obstruction led to Taiwan being denied an invitation to the 70th WHA as an observer last year. The WHO not only failed to abide by its Constitution, but also ignored widespread calls for Taiwan’s inclusion coming from many nations and international medical groups all around the world.
Despite this, Taiwan remains committed to helping enhance regional and global disease prevention networks, and assisting other countries in overcoming their healthcare challenges.
Taiwan is seeking to participate in the 71st WHA this year in a professional and pragmatic way, as part of global efforts to realise the WHO’s vision of a seamless global disease prevention network.
This is also in line with UN Sustainable Development Goal 3, which is to ensure healthy lives and promote wellbeing for all at all ages by 2030.
We therefore urge the WHO and related parties to acknowledge Taiwan’s longstanding contributions to promoting human health worldwide, and to recognise the significance and legitimacy of Taiwan’s involvement as an observer in this year’s WHA. Because we believe that to achieve health for all, Taiwan can help.
• Dr. Chen Shih-Chung is Taiwan’s Minister of Health and Welfare