Healthcare in Taiwan

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Ministry of Health and Welfare (Taiwan) ROC-MOHW Building 20131013.jpg
Ministry of Health and Welfare (Taiwan)
Emblem of National Health Insurance ROC National Health Insurance Emblem.svg
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]

Contents

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

Taiwan has the best healthcare system in the world, according to the 2023 edition of the CEOWORLD magazine Health Care Index,Of the 110 countries surveyed, Taiwan’s healthcare comes in 1st place on the list, scoring 78.72 out of 100 on the Health Care Index. [4]

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. [5] 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. [6] 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. [7] Taiwan has shifted its approach to allow its country to set structures and functions for other countries to follow. [8] 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. [9]

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. [10]

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. [10]

In July 2013, the Department of Health was restructured as the Ministry of Health and Welfare. [11]

Healthcare reform

National Health Insurance Administration Gongbao Xinyi Building, Central Trust of China 20160706.jpg
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. [12]

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. [13] Healthcare bills were fast-tracked through the Legislative Yuan between 1993 and 1994. [13] [14]

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. [15] 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." [16] [17]

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. [9] 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. [9] 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. [18]

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. [19]

≈ 1906≈ 1998 [20] ≈ 2012 [21] [22]
Life expectancyM: 39 years; F: 43 yearsM: 72 years; F: 78 yearsM: 76 years; F: 83 years
Infant mortality84.1 per 1,000 live births6.14 per 1,000 live births5.10 per 1,000 live births
Maternal mortality7.6 per 1,000 live births0.9 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. [23] 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. [18] [24]

Patients have largely been satisfied with the system, with satisfaction rates consistently reaching 80% in recent years. [25] 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. [18]

Taiwan has the lowest administration cost in the world of 2 percent. [18] Before NHI, Taiwan spent 4.7 to 4.8 percent[ clarification needed ] 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. [12] Taiwan spent a little over 6 percent in GDP and less than US$900 per person. [26]

Facilities and coverage

As of 2017, the NHI Facility Contract Distribution facilities total 28,339, including: [27]

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

Basic coverage areas of the insurance include:

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%. [9] The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians, [28] and infrequently raised. [14]

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. [9] Patients visit the doctor more frequently causing doctors to keep visits to about 2 to 5 minutes per patient. [29] 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. [30]

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. [31] [32]

Inequality

Doctors per 10,000 people. [33]
RegionPhysicianSurgeonPediatrician
Taipei5.011.771.11
Kaohsiung-Pingtung-Taitung2.120.820.46
Healthcare providers per Kilometer. [33]
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. [34] All residents have a national health insurance card that allows health providers to access their medical information, including visits, prescriptions, and vaccinations. [35]

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 Life expectancy in Taiwan.svg
Historical development of life expectancy in Taiwan
PeriodLife expectancy in
years [36] 		PeriodLife expectancy in
years [36]
1950–195558.21985–199073.4
1955–196062.91990–199574.4
1960–196565.01995–200075.2
1965–197066.92000–200576.9
1970–197569.42005–201078.2
1975–198070.82010–201579.2
1980–198572.12015–202081.0

See also

Related Research Articles

Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

<span class="mw-page-title-main">Comparison of the healthcare systems in Canada and the United States</span> Healthcare system comparison

A comparison of the healthcare systems in Canada and the United States is often made by government, public health and public policy analysts. The two countries had similar healthcare systems before Canada changed its system in the 1960s and 1970s. The United States spends much more money on healthcare than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on healthcare in that year; Canada spent 10.0%. In 2006, 70% of healthcare spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on healthcare was 23% higher than Canadian government spending. U.S. government expenditure on healthcare was just under 83% of total Canadian spending.

Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system.

National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector, or a combination of both. Funding mechanisms vary with the particular program and country. National or statutory health insurance does not equate to government-run or government-financed health care, but is usually established by national legislation. In some countries, such as Australia's Medicare system, the UK's National Health Service and South Korea's National Health Insurance Service, contributions to the system are made via general taxation and therefore are not optional even though use of the health system it finances is. In practice, most people paying for NHI will join it. Where an NHI involves a choice of multiple insurance funds, the rates of contributions may vary and the person has to choose which insurance fund to belong to.

The healthcare reform in China refers to the previous and ongoing healthcare system transition in modern China. China's government, specifically the National Health and Family Planning Commission, plays a leading role in these reforms. Reforms focus on establishing public medical insurance systems and enhancing public healthcare providers, the main component in China's healthcare system. In urban and rural areas, three government medical insurance systems—Urban Residents Basic Medical Insurance, Urban Employee Basic Medical Insurance, and the New Rural Co-operative Medical Scheme—cover almost everyone. Various public healthcare facilities, including county or city hospitals, community health centers, and township health centers, were founded to serve diverse needs. Current and future reforms are outlined in Healthy China 2030.

<span class="mw-page-title-main">Health care in Australia</span> Availability, funding, and provision of health services in Australia

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Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

<span class="mw-page-title-main">Health care in Turkey</span> Overview of the health care system in Turkey

Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures.

<span class="mw-page-title-main">Healthcare in South Korea</span> Overview of the healthcare in South Korea

Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of Health and Welfare to which South Koreans of sufficient income must pay contributions in order to insure themselves and their dependants, and the Medical Aid Program, a social welfare program run by the central government and local governments to insure those unable to pay National Health Insurance contributions. In 2015, South Korea ranked first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea was rated as the second most efficient healthcare system by Bloomberg. Health insurance in South Korea is single-payer system. The introduction of health insurance resulted in a significant surge in the utilization of healthcare services. Healthcare providers are overburdened by government taking advantage of them.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

<span class="mw-page-title-main">Healthcare in Ghana</span>

Healthcare in Ghana is mostly provided by the national government, and less than 5% of GDP is spent on healthcare. The healthcare system still has challenges with access, especially in rural areas not near hospitals.

<span class="mw-page-title-main">Healthcare in Estonia</span>

Healthcare in Estonia is supervised by the Ministry of Social Affairs and funded by general taxation through the National Health Service.

Healthcare in Georgia is provided by a universal health care system under which the state funds medical treatment in a mainly privatized system of medical facilities. In 2013, the enactment of a universal health care program triggered universal coverage of government-sponsored medical care of the population and improving access to health care services. Responsibility for purchasing publicly financed health services lies with the Social Service Agency (SSA).

There were a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.

Examples of health care systems of the world, sorted by continent, are as follows.

References

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