Minister of Health and Welfare Chen Shih-chung discusses how Taiwan Can Help achieve the World Health Organization’s vision of Health For All.
Taiwan Today (TT): Taiwan’s National Health Insurance (NHI) system has been operating since March 1995. What makes the program stand out as a successful example of universal health coverage?
Chen Shih-chung: NHI coverage spans both Western and traditional Chinese medicine as well as dental, childbirth and rehab care. These are all available under the NHI with premiums scaling according to how much someone earns, which ensures fairness.
The system is continuously expanding to cover new medications and treatments based on evaluations of effectiveness and affordability. For example, a new drug for treating hepatitis C was introduced in January 2017, and immune checkpoint inhibitors have been used in cancer immunotherapy since April 2019.
This is all possible while covering more than 99 percent of people living in Taiwan. In a survey conducted by the Ministry of Health and Welfare (MOHW) last year, 89.7 percent of respondents expressed satisfaction with the NHI, the highest approval rate in the system’s history. According to the Health Care Index compiled by [online business magazine] CEOWORLD, Taiwan’s health care system ranked first among 89 countries and territories.
TT: The efficiency of the system owes much to projects promoting digital health. Can you cite some examples?
Chen: I must praise the NHI MediCloud System, via which patients’ medical records can be shared among staffers at different hospitals and clinics. This helps prevent physicians prescribing the same medications or ordering the same tests for a patient, reducing medical resource wastage.
For patients, the My Health Bank tool provides easy access to medical records to assist with health management. People can access medical history from the past three years using mobile devices.
TT: The World Health Organization (WHO) has designated 2020 as the Year of the Nurse and Midwife. Can you tell us more about the roles these professions play in Taiwan’s health care system?
Chen: These two professions absolutely lie at the heart of health care in Taiwan, as they do in systems around the world. They play key roles in fulfilling the WHO’s Health For All mission. Approximately 174,000 nurses and 179 midwives are currently practicing in Taiwan. To level-up skills in these sectors, the MOHW has held tests for licensed nurses since 2006 and provided extra training. Last year the annual exam for nurses was made biannual to encourage more nurses to advance their careers.
The MOHW has also invested heavily in nursing in the community with the establishment of home care nursing centers, from which nurses can visit patients in their own homes. By providing guidance and training sessions to interested individuals and organizations, the ministry is expecting 1,000 of these centers to open by 2025.
Global networking is also important for the sectors’ development. An international seminar is scheduled to take place in Taipei City in September bringing together nursing professionals from home and abroad. Co-organized by Taiwan Nurses Association and International Council of Nurses [the largest organization of its kind worldwide], the event is expected to attract about 200 attendees.
TT: Taiwan is gaining worldwide recognition for its efforts combating coronavirus, performing well to date compared with other developed nations during the COVID-19 pandemic. What has been the secret to this success?
Chen: We gained valuable insights from Taiwan's experience controlling the devastating SARS outbreak in 2003, which helped shape our current response to COVID-19.
Shortly after the SARS outbreak, Taiwan promulgated the regulations governing the Central Epidemic Command Center in 2004 to give the government power to establish a dedicated workforce to address major public health emergencies. Improvements have since been made in various aspects such as implementing an optimized surveillance system, strengthened border controls and quarantine rules, and enhanced contagious diseases screening.
Thanks to the lessons learned and changes made, Taiwan is always vigilant and can respond to an outbreak promptly. As a result, despite being widely predicted to be one of the countries hardest hit by the virus due to our geographical proximity to China, Taiwan has so far reported fewer cases than Japan, South Korea, the U.S. and many European countries. So, I think Taiwan deserves the recognition we have received from the international community.
TT: What measures has Taiwan taken specifically since the world first learned of COVID-19?
Chen: As soon as 27 cases of pneumonia with unknown cause were first reported in Wuhan, China on Dec. 31, 2019, Taiwan decided to conduct onboard quarantine on all flights from Wuhan, the epicenter of the outbreak. This was the first key step in successfully containing the disease’s spread in Taiwan. We have since taken measures to minimize the risk of imported cases, such as closely tracking and tracing people traveling from high-risk areas, and constantly reviewing and updating our immigration policies as the situation evolves.
Slowing community spread is another one of our key strategies. Our public health and civil authorities work with the police in a coordinated effort to manage people under home isolation or quarantine. Such interagency collaboration ensures the effectiveness of these measures and lessens the burden on public health agencies. In addition, we passed the Special Act for Prevention, Relief and Revitalization Measures for Severe Pneumonia with Novel Pathogens [on Feb. 25] which stipulates that those who fail to meet the obligation of mandatory quarantine will be fined, while those who fully comply with the requirements will be entitled to monetary compensation.
TT: How is technology being utilized in the fight against the disease?
Chen: We track the cellphone locations of quarantined individuals to ensure they remain at home. We have also combined the databases of the National Health Insurance Administration, National Immigration Agency and Taiwan Centers for Disease Control to leverage big data analysis. For example, when accessing a patient’s record with his or her NHI card, health care providers will be alerted if the patient has recently visited a high-risk area or had close contact with confirmed cases of COVID-19. In the absence of his or her NHI card, the patient's ID number may alternatively be used to access travel and contact histories. This ensures health care providers have full disclosure of relevant exposure information.
In addition, to prevent panic buying and ensure public access to surgical masks, ICT professionals spent two days modifying and testing the NHI’s databases to create a name-based mask distribution system. The program was introduced on Feb. 6 and allows the public to purchase masks at a standard price with a weekly quota using an NHI card by visiting public health centers, NHI-contracted pharmacies and drugstores. This initiative has proven effective at a time when there is a global shortage of personal protective equipment.
TT: As cases continue to rise globally, is Taiwan working on medical breakthroughs that could help ease the situation?
Chen: The National Health Research Institutes (NHRI) launched various projects for combating coronavirus shortly after its discovery at the end of last year. As the only organization in Taiwan qualified to produce blood serum from horses injected with the virus, NHRI is now preparing an equine serum for testing on patients with COVID-19 who are in a critical condition at its National Institute of Infectious Diseases and Vaccinology (NIIDV).
Regarding inoculation, NIIDV is focusing on peptide vaccines but is also developing other types. If everything goes as planned, human clinical trials can start shortly. It is also developing a rapid test using SARS antibodies capable of detecting the COVID-19 coronavirus.
NHRI’s Institute of Biotechnology and Pharmaceutical Research has also conducted trials synthesizing up to one gram of remdesivir, an experimental antiviral with potential to treat COVID-19. This paves the way for mass production in case of a major outbreak. In addition, the institute is using artificial intelligence to select medicines most likely to successfully treat COVID-19, with a focus on drugs that can inhibit SARS and are already on the market.
TT: Does this pandemic highlight the importance of Taiwan participating in the World Health Assembly (WHA)? What contributions can Taiwan make?
Chen: The global pandemic response is incomplete without Taiwan. As we're situated strategically between East and Southeast Asia, our absence in coordinated international health efforts can lead to disastrous consequences.
We know from our SARS experience that global cooperation is indispensable in the fight against a contagious disease. Therefore, as a responsible member of the global community, Taiwan has committed to observing the International Health Regulations since the beginning of the COVID-19 outbreak, duly investigating and reporting confirmed cases to the WHO. We have also kept China, Japan, South Korea, Singapore and the EU up to date on the situation in Taiwan, as well as uploading information on viral sequences to the database of the Global Initiative on Sharing All Influenza Data.
Admitting Taiwan to the WHA will allow our officials to engage in discussions with public health leaders from around the world and secure access to timely information. It will also be an occasion where Taiwan can share our experiences in areas such as testing, diagnosis, border control and community outbreak prevention. To avoid a repeat of the current pandemic and effectively ensure global health security, the world must take action to improve communication and transparency.