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Taiwan |
PROLOGUE
Universal Coverage In Taiwan
PROLOGUE: Taiwan is the most recent advanced economy to adopt a universal health insurance program. After seven years of substantial progress, Taiwan’s National Health Insurance (NHI) program has received little attention from the international health policy community. This may be because Taiwan is not a member of the World Health Organization (WHO) or the Organization for Economic Cooperation and Development (OECD), which provide worldwide data and analysis for health policymakers. Yet as the authors of the following two papers note, Taiwan’s progress in providing universal health coverage for its citizens while constraining the growth of health costs offers important lessons.
Taiwan’s insurance program offers free choice of providers for its citizens and free choice of practice modes for providers. The lack of waiting lists and success in holding down growth of health costs may also make the system more appealing to U.S. policymakers who are considering an expansion of health care coverage. Indeed, the notion of a single-payer system has emerged again for debate in Congress. In February 2003 Rep. John Conyers (D-MI) and Rep. Jim McDermott (D-WA) introduced a single-payer health system bill in which the federal government would finance but not administer the system. The legislation would expand Medicare to all U.S. residents, thus keeping the current system of private physicians and hospitals intact. Conyers and McDermott propose financing the system through the existing Medicare payroll tax and a new payroll tax.
Yet even if a single-payer system does not come to pass for Americans, Taiwan’s experience may still offer lessons for the current Medicare system. The paper here by Tsung-Mei Cheng notes that the growing pains Taiwan experienced, along with its government’s responses to these problems, may be of particular interest to U.S. and Canadian readers. She writes, "Americans, whose public health policy has been hostage to political gridlock for almost two decades, should be impressed with Taiwan’s bold embrace and implementation of universal health insurance. For their part, policymakers in Taiwan...might take solace in the fact that the thirty-seven-year-old U.S. Medicare and Medicaid programs still wrestle with the very same problems." Cheng received her law degree from National Taiwan University and a master’s degree in international relations from Yale University. She hosts the International Forum at Princeton University’s International Center.
Jui-Fen Rachel Lu and William Hsiao provide new data to analyze the impact of Taiwan’s insurance program. They write: "One notable result that should interest Americans is that Taiwan’s...system greatly reduced transaction costs and also offered the information and tools to manage health care costs." Lu is chair of the Department of Health Care Management at Chang Gung University, in Taiwan. Hsaio, an economics professor at Harvard, and colleagues developed the resource-based relative value scale (RBRVS) for the United States.
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