Taiwan started its health reform in the 1980s after experiencing two decades of economic growth.[3] In 1987, the government did away with the martial 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. 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.[4]

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.[5]

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 a kilobyte of memory that includes provider and patient profiles to identify and reduce Insurance Fraud, overcharges, duplication of services and tests.[7] 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 of over prescribing medications as well as keeps patients from abusing the system.[4]

Patients and doctors alike are very satisfied with NHI. Satisfaction has been in the 70 percent range. However, 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.[4]

Taiwan has the lowest administration cost in the world of 2 percent.[4] 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.[3] Taiwan spends a little over 6 percent in GDP and less than US $900 per person.[8]

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.[9] The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians[10] 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.[11] There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events.

In November 2004, the Department of Health announced that Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) had become an increasingly serious problem in Taiwan.[1] The first reported case surfaced in 1984.[1] In 2004 there were 6,850 known cases, with 92.9 percent of the infections occurring in Taiwanese and 7.1 percent in foreigners.[1] In 2003 there were 860 new cases of HIV infections, and by October 2004, 1,120 new cases were confirmed on the island.[1] This announcement was followed by the launching of a new public awareness campaign.