Taiwan provides a template for the achievement of universal health care and is ready and willing to share its expertise.
The right to health, a founding ideal and core objective of the World Health Organization (WHO), is realized in Taiwan through the National Health Insurance (NHI) program. Launched in 1995, the compulsory plan covers virtually 100 percent of the population. It offers users affordable and convenient access to inpatient and outpatient services, dental care, prescription medications and traditional Chinese treatments.
According to Minister of Health and Welfare Chen Shih-chung (陳時中), equity and inclusivity are the cornerstones of the system. “The NHI is based on the principle of leaving no one behind. All citizens and foreign residents are enrolled. It also ensures fairness by setting premiums as a proportion of a person’s income,” he said.
Through the program, the NHI Administration (NHIA) under the Ministry of Health and Welfare (MOHW) is the single payer for all medical services. “This arrangement ensures high levels of efficiency by significantly reducing administrative spending,” Chen said, adding that related expenses accounted for 0.9 percent of the total in 2017, the lowest proportion in the world.
This efficiency translates into short wait times and cost-effective care, earning the system widespread acclaim at home and abroad. According to a 2017 MOHW survey, 85.8 percent of respondents expressed satisfaction with the program. In addition, more than 50 foreign delegations visited Taiwan last year alone to learn about the NHI.
The National Health Insurance program offers nearly every citizen and foreign resident access to a wide range of services spanning Western and traditional Chinese medicine as well as dental care. (Photo by Huang Chung-hsin)
Global Priority
WHO Director-General Tedros Adhanom Ghebreyesus has identified promoting universal health coverage as the global body’s top priority. Shortly after beginning his five-year term in July 2017, Tedros wrote in The Lancet medical journal that countries can learn from peers and embrace innovative, tailored solutions to achieve this objective.
As evidenced by the NHI, Taiwan has accumulated world-leading expertise in the field, Chen said. It would relish the opportunity to share its experiences by participating in the 71st World Health Assembly (WHA), the decision-making body of the WHO, May 21-26 in Geneva, he added. Taiwan attended the annual assembly as an observer from 2009 to 2016 following 38 years of exclusion. Its involvement is widely recognized as helping strengthen global health and disease prevention.
According to the minister, the NHI can serve as a blueprint for nations around the world. In addition to controlling costs, the system has led to continuous advancements in public health, with average life expectancy in Taiwan rising from 74.5 to 80.2 years since its launch.
These gains result from consistent efforts to extend NHI coverage. In 2013, the nation’s 60,000 prison inmates were added to the program. And in December 2017, babies born in Taiwan to foreign residents—previously eligible to join after a six-month waiting period—were included at birth. Chen said these measures underscore the country’s respect for health care as a fundamental human right.
The government also regularly expands the range of medications and treatments available under the system. A recent example is the inclusion in January 2017 of cutting-edge antiviral hepatitis C drugs for patients with advanced forms of the disease. This was a significant step as the illness, a major cause of liver cancer, is estimated to affect up to 600,000 people in the country, according to statistics from Taiwan nonprofit Liver Disease Prevention and Treatment Research Foundation.
In 2017, the NHIA allocated NT$2.4 billion (US$80 million) for the highly effective oral hepatitis C medications, providing the drugs to 9,538 patients. A total of NT$4.3 billion (US$143.3 million) has been earmarked for 2018 with the goal of helping an additional 17,000 people. “This is money well spent. Dealing with the disease now will save a lot in the long term by preventing more serious health conditions,” Chen said.
A physician performs an abdominal ultrasound to check the health of a patient’s liver. The NHI covers cutting-edge antiviral hepatitis C medications for people with advanced forms of the disease as part of government efforts to reduce liver cancer rates. (Photo courtesy of Liver Disease Prevention and Treatment Research Foundation)
Technological Solutions
A key contributor to the program’s efficiency—as well as a source of great interest to foreign delegations—is the NHI’s powerful information technology infrastructure. Since 2015, the vast majority of hospitals and clinics in Taiwan have been connected to a cloud computing network, allowing physicians to quickly and easily locate patient medical records. This boosts service quality and safety by, for instance, enabling health care providers to avoid prescribing double doses of drugs. In January 2018, the network was further upgraded into a file-sharing platform for diagnostic images such as CT scans.
Epidemic prevention is another advantage of the centralized system. In the case of emergency situations such as the 2003 outbreak of severe acute respiratory syndrome, or SARS, authorities can request real-time updates of records, enabling rapid identification of potential patients.
According to Chou Jih-haw (周志浩), director-general of the Centers for Disease Control (CDC) under the MOHW, Taiwan has accumulated extensive expertise in epidemic containment and prevention. The country operates comprehensive infrastructure at borders and international gateways for detecting illnesses like bird flu and dengue fever. “We also analyze information about outbreaks of other infectious diseases around the world on a daily basis so we can quickly implement response measures like observing visitors from affected countries at airports,” Chou said.
Taiwan is quick to report any issues to the WHO, as with the most recent H7N9 patient in February 2017. Six months earlier, the CDC also informed its U.S. counterpart about a Zika virus case involving an American arrival, helping confirm suspicions that the mosquito-borne disease was spreading in Miami-Dade County, Florida.
To strengthen Taiwan’s contributions to global health development, in 2015 the CDC began hosting disease-fighting training camps in cooperation with the U.S. Under the initiative, the former provides funding and facilities while the latter arranges for leading international experts to participate. Six events have been staged in Taiwan to date, offering health officials and technicians from 18 Asian countries knowledge of diagnostic strategies for chikungunya, dengue fever, Ebola, MERS, or Middle East respiratory syndrome, and Zika. Attendees also used the occasions to bolster regional disease prevention and monitoring networks.
The most recent camp, held April 23-26 in Taipei City, focused on illnesses caused by enteroviruses. Chou said that Taiwan has amassed considerable expertise in the diseases, which disproportionally affect children and remain common in much of Southeast Asia.
Foreign medical professionals learn how to conduct a single test for chikungunya, dengue fever and Zika at a training camp jointly organized by Taiwan and the U.S. in Taipei City last year. (Photo courtesy of Centers for Disease Control)
International Participation
Given its world-leading universal health care system and commitment to helping regional partners, Taiwan warrants inclusion in the WHA, according to Wang Pi-sheng (王必勝), secretary-general of the Taiwan Medical Association. The nation’s largest nongovernmental medical group plays an important role in strengthening connections between local and foreign health care professionals. Among other measures, it hosted the 2016 general assembly of the World Medical Association in Taipei.
Results of the event include the Declaration on Ethical Consideration regarding Health Databases and Biobanks, also known as the Declaration of Taipei. “This underscored recognition of Taiwan’s efforts to ensure appropriate collection and use of patient and specimen data,” Wang said.
The nation’s inclusion in the WHA is needed to plug a gap in the global disease control network, he said. “This is crucial given Taiwan’s status as a major regional transfer hub for people and cargo.”
Chen similarly stressed the importance of the nation’s participation in the assembly. “Face-to-face interactions build mutual trust and forge partnerships—key facets in strengthening the global disease control network. Through technical meetings at the WHA, Taiwan can learn from other countries and give back by sharing its health care expertise.”
Write to Oscar Chung at mhchung@mofa.gov.tw