Ministry of Health and Welfare (Taiwan)
Emblem of National Health Insurance

Healthcare in Taiwan is administered by the Ministry of Health and Welfare 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.[1] In 2002 Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population.[1] In 2002, there were 36 hospitals and 2,601 clinics in the country. Per capita health expenditures totaled US$752 in 2000.[1] Health expenditures constituted 5.8 percent of the gross domestic product (GDP) in 2001 (or US$951 in 2009[2]); 64.9 percent of the expenditures were from public funds.[1] Overall life expectancy in 2019 was averaged at 81 years.[3]

Recent major health issues include the SARS crisis in 2003, though the island was later declared safe by the World Health Organization (WHO).[1]

National Health Insurance

The current healthcare system in Taiwan, known as National Health Insurance (NHI, Chinese: 全民健康保險), was instituted in 1995. NHI is a single-payer compulsory social insurance plan that centralizes the disbursement of healthcare funds. The system promises equal access to healthcare for all citizens, and the population coverage had reached 99% by the end of 2004.[4] 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 public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare 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.

The implementation of universal healthcare created fewer health disparities for lower-income citizens in Taiwan. Additionally, life expectancy increased more in health class groups that had higher mortality rates before national health insurance was introduced.[5] Life expectancy in Taiwan is about 80 years old as of 2018. Infant mortality rate is low and only 4 deaths for 1,000 live births as well as fertility rates are very high and stable.[6] Taiwan has shifted its approach to allow its country to set structures and functions for other countries to follow.[7] Although there are many different people to tend to including the disabled, Taiwan has catered to its best ability and also supported more than 23.4 million citizens to provide this universal healthcare.[8]

History

Modern medicine only reached Taiwan after the Japanese invasion in 1895. Disease was one of the biggest challenges faced by the Japanese in their early years on Taiwan, a Japanese Prince who was part of the invasion force died of malaria. The Japanese introduced western medicine and modern sanitation practices. The introduction of water purification plants reduced the spread of cholera and other diseases. Communicable disease was a major issue, a plague outbreak lasted from 1898 to 1918. Malaria was reduced through the draining of wetlands and the clearing of bamboo forests.[9]

Following the retreat of the KMT to Taiwan healthcare consisted of a mix of Japanese era institutions and military/veterans institutions which the KMT brought with them along with 1.5 million troops and civilians. Healthcare continued to be almost entirely a government concern until the 1970s when a number of Taiwan’s leading industrial groups opened hospitals.[9]

In July 2013, the Department of Health was restructured as the Ministry of Health and Welfare.[10]

Healthcare reform

National Health Insurance Administration

Taiwan started its health reform in the 1980s after experiencing two decades of economic growth, the period often referred to as the Taiwanese Miracle.[11]

In 1987, the government ended the martial law that mobilized the governmental departments. The government set up a planning commission and studied other countries' healthcare systems. Taiwan looked at more than ten countries and combined their best qualities to form their own unique system.[12] Healthcare bills were fast-tracked through the Legislative Yuan between 1993 and 1994.[12][13]

On 1 March 1995, Taiwan formed the National Health Insurance (NHI) model, following the passage of the National Health Insurance Act on 19 July 1994.[14] In a 2009 interview, 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 [in the USA]. And there are 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."[15][16]

NHI delivers universal coverage offered by a government-run insurer, covering outpatient visits, inpatient care, dental care, traditional Chinese medicine, renal dialysis, and prescription drugs.[8] 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. There are no financial barriers to receiving the medical care required by an individual.[8] That way, Taiwan's citizens are less prone to bankruptcy as a result of medical bills, according to Hongjen Chang, one of the architects of the system.[17]

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 or changing their 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.[18]

≈ 1906 ≈ 1998[19] ≈ 2012[20][21]
Life expectancy M: 39 years; F: 43 years M: 72 years; F: 78 years M: 76 years; F: 83 years
Infant mortality 84.1 per 1,000 live births 6.14 per 1,000 live births 5.10 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. This credit-card-size card contains 32 kilobytes of memory that includes provider and patient profiles to identify and reduce insurance fraud, overcharges, duplication of services and tests.[22] 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, use and quality of treatment for diagnosis by requiring the providers to submit a full report every 24 hours. This improves quality of treatment, limits physicians from over-prescribing medications, and keeps patients from abusing the system.[17][23]

Patients have largely been satisfied with the system, with satisfaction rates consistently reaching 80% in recent years.[24] However, doctors have been more dissatisfied because fee premiums are controlled 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 many 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 healthcare 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 healthcare, have greater financial risk protection and have equity in healthcare financing.[17]

Taiwan has the lowest administration cost in the world of 2 percent.[17] Before NHI, Taiwan spent 4.7 to 4.8 percent on healthcare. A year after NHI, it increased spending to 5.39 percent. Before NHI, the average annual rate of increase every year was around 13 percent. In 2007, the annual rate of increase is around 5 percent.[11] Taiwan spent a little over 6 percent in GDP and less than US$900 per person.[25]

Facilities and coverage

As of 2017, the NHI Facility Contract Distribution facilities total 28,339, including:[26]

NumberSubject
20,271 outpatient-only facilities
6,662 dental clinics
3,589 Chinese medicine clinics
809 inpatient/outpatient facilities
364 local community hospitals
5 Chinese medicine hospitals
26 academic medical centres

Basic coverage areas of the insurance include:

  • In-patient care
  • Ambulatory care
  • Laboratory tests
  • Prescription and over-the-counter drugs
  • Dental services
  • Mental Illness
  • Traditional Chinese medicine
  • Home care
  • Preventative services (check-ups, prenatal care, pap smears)

Problems

Even with all their success in their healthcare system, Taiwan has suffered many misfortunes. From 1996 to 2008, the average annual growth rate of expenditures was 5.33%, which outstripped the growth rate of revenue at 4.43%.[8] The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians,[27] and infrequently raised.[13]

There is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. There is also a shortage of nurses.[8] Patients visit the doctor more frequently causing doctors to keep visits to about 2 to 5 minutes per patient.[28] Also, the system is based on a global budget, meaning it has no regard for faculties of risk (surgery, internal medicine, gynaecology, pediatrics, emergency), which affects the medicine, operation and diagnostic tools (X-ray vs. MRI) prescribed.[29]

Due to a decrease in funds available, and with no systems in place to screen patients, all patients will rush to hospitals regardless of terminal patients or general cold, many smaller, but long-serving district hospitals are forced to downscale, or close down and be demolished.[30][31]

Inequality

Doctors per 10,000 people.[32]
RegionPhysicianSurgeonPediatrician
Taipei5.011.771.11
Kaohsiung-Pingtung-Taitung2.120.820.46
Healthcare providers per Kilometer.[32]
RegionCount
Taipei42.89
Kaohsiung-Pingtung-Taitung4.9

Electronic health records

Taiwan implemented a national electronic health record system beginning with a 3-year plan in 2009.[33] All residents have a national health insurance card that allows health providers to access their medical information, including visits, prescriptions, and vaccinations. [34]

Nursing

The Ministry of Health and Welfare was in charge of nurses regulation in Taiwan. Nursing was a licensed profession, which provide further of specialist education.

Life expectancy and infant mortality data

Historical development of life expectancy in Taiwan
Period Life expectancy in
years[35]		 Period Life expectancy in
years[35]
1950–1955 58.2 1985–1990 73.4
1955–1960 62.9 1990–1995 74.4
1960–1965 65.0 1995–2000 75.2
1965–1970 66.9 2000–2005 76.9
1970–1975 69.4 2005–2010 78.2
1975–1980 70.8 2010–2015 79.2
1980–1985 72.1 2015–2020 81.0

See also

References

  1. 1 2 3 4 5 "Taiwan country profile" (PDF). Library of Congress Federal Research Division. March 2005. Archived (PDF) from the original on 2015-03-29. Retrieved 2008-05-04. This article incorporates text from this source, which is in the public domain.
  2. ↑ GDP data refer to the year 2009. World Economic Outlook Database-April 2010 Archived 2011-05-14 at the Wayback Machine, International Monetary Fund. Accessed on 24 April 2010.
  3. ↑ Average life expectancy hits 80.86 in Taiwan
  4. ↑ Fanchiang, Cecilia."New IC health insurance card expected to offer many benefits" Archived 2008-06-06 at the Wayback Machine, Taiwan Journal, January 2nd, 2004 Accessed 28 March 2008
  5. ↑ Wen, Chi Pang; Tsai, Shan Pou; Chung, Wen-Shen Isabella (19 February 2008). "A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity". Annals of Internal Medicine. 148 (4): 258–67. doi:10.7326/0003-4819-148-4-200802190-00004. PMID 18283203.
  6. ↑ "East Asia/Southeast Asia :: Taiwan — The World Factbook - Central Intelligence Agency". www.cia.gov. Retrieved 2018-12-02.
  7. ↑ 衛生福利部 (2017-01-09). "Ministry of Health and Welfare". www.mohw.gov.tw. Archived from the original on 2018-12-03. Retrieved 2018-12-02.
  8. 1 2 3 4 5 Cheng, Tsung-Mei (14 May 2015). "Taiwan's health care system: The next 20 years". Brookings. Archived from the original on 9 December 2017. Retrieved 2017-12-08.
  9. 1 2 Rickards, Jane (25 November 2020). "Tracking Taiwan's Medical History". topics.amcham.com.tw. Topics.
  10. ↑ Hsiao, Alison (24 July 2013). "Ministry of Health and Welfare completes restructuring". Taipei Times. Retrieved 5 November 2013.
  11. 1 2 Reid, T.R. (2008). "FRONTLINE: Sick Around the World". Public Broadcasting Service. Archived from the original on 2017-08-26. Retrieved 2017-08-29.
  12. 1 2 Reinhardt, Uwe E. (12 January 2008). "Humbled in Taiwan". BMJ. 336 (72): 7635. doi:10.1136/bmj.39450.473380.0F. PMC 2190287. PMID 18187722. After visiting the health systems of numerous other nations, Taiwan's policy planners used the insights gained to develop what has been described as "a car made from many parts produced abroad but assembled in Taiwan."
  13. 1 2 Scott, Dylan (13 January 2020). "Taiwan's single-payer success story — and its lessons for America". Vox. Retrieved 1 November 2020.
  14. ↑ Han Cheung (14 July 2019). "Taiwan in Time: Saying no to universal healthcare". Taipei Times. Archived from the original on 14 July 2019. Retrieved 15 July 2019.
  15. ↑ "Jonathan Cohn interviews Taiwan's Dr. Michael Chen: The Case for Single-Payer Health Care (Transcript)". Archived from the original on 2009-09-21. Retrieved 2009-09-11.
  16. ↑ "TRNtv:Jonathan Cohn interviews Taiwan's Dr. Michael Chen (Video)". Retrieved 11 September 2009.
  17. 1 2 3 4 "Taiwan Takes Fastrack to Universal Health Care". All Things Considered, NPR. 2008-04-15. Archived from the original on 2008-08-13. Retrieved 2008-10-05.
  18. ↑ Jui-Fen Rachel Lu; William C. Hsiao (2003). "Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan". Health Affairs. 22 (3): 77–88. doi:10.1377/hlthaff.22.3.77. PMID 12757274.
  19. ↑ Source: Lee, Ming-Liang (2001-05-14). Health Care in Taiwan — Past, Present and Future. 54th World Health Assembly. Archived from the original on 2007-05-07. Retrieved 2008-05-01.
  20. ↑ "The World Factbook: Life Expectancy at Birth". The World Factbook. Central Intelligence Agency. Archived from the original on 20 January 2016. Retrieved 20 August 2012.
  21. ↑ CIA on Infant Mortality (2009)
  22. ↑ Chen, Yuh-Ning (September 2003). "Taiwan'S Health IC Smart Card Security and Privacy Policy" (PDF). Archived (PDF) from the original on 2008-09-05. Retrieved 2008-03-16.
  23. ↑ Pang Wen Chi, Pou Tsai Shan, Isabella Chung Wen-Shen (2008). "A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity". Annals of Internal Medicine. 148 (4): 258–67. doi:10.7326/0003-4819-148-4-200802190-00004. PMID 18283203.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ↑ "National Health Insurance Report 2015-2016" (PDF). National Health Insurance. Archived (PDF) from the original on 2017-12-08. Retrieved 2017-12-08.
  25. ↑ Ian Williams (2007-10-07). "Taiwan gets healthy". The Guardian. Archived from the original on 2008-03-24. Retrieved 2008-05-01.
  26. ↑ 106年全民健康保險統計 (PDF) (in Chinese (Taiwan)). Taiwan NHIA. Retrieved 26 February 2019.
  27. ↑ Lee, Lung-Sheng (1999). "Is the Multi-HMO System a Promising Candidate for National Health Insurance Reform in Taiwan?". B>Quest. Archived from the original on 2008-09-06. Retrieved 2008-05-01.
  28. ↑ Gunde, Richard (2004-09-30). "Healthcare in Taiwan: Successes and Challenges". Archived from the original on 2016-04-08. Retrieved 2016-03-29.
  29. ↑ TVBS NEWS (2015-05-19), 台灣健保20年「收費低」病患享受醫師災難, retrieved 2017-10-02
  30. ↑ 東森新聞 CH51 (2016-05-28), 「厝邊好醫生」消失危機！健保20年 小醫院倒一半【3600秒】, retrieved 2017-10-02{{citation}}: CS1 maint: numeric names: authors list (link)
  31. ↑ Wu, Tai-Yin; Majeed, Azeem; Kuo, Ken N. (2010). "An overview of the healthcare system in Taiwan". London Journal of Primary Care. 3 (2): 115–119. doi:10.1080/17571472.2010.11493315. PMC 3960712. PMID 25949636.
  32. 1 2 自由評論網 (2020-01-06). "高教展望》五大專科醫師人力 南部明顯不足". 自由電子報 自由評論網 (in Chinese). Archived from the original on 2020-01-06. Retrieved 2020-03-05.
  33. ↑ Li, Yu-Chuan (Jack); Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei (2015-08-01). "Building a National Electronic Medical Record Exchange System – Experiences in Taiwan". Computer Methods and Programs in Biomedicine. 121 (1): 14–20. doi:10.1016/j.cmpb.2015.04.013. PMID 26001420.
  34. ↑ "The 2020 International Profiles of Health Care Systems: A Useful Resource for Interpreting Country Responses to the COVID-19 Pandemic". Commonwealth fund. 10 June 2020. Retrieved 24 June 2020.
  35. 1 2 "World Population Prospects – Population Division – United Nations". Retrieved 15 July 2017.
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