Taiwan: National Health Insurance (NHI)

Taiwan: National Health Insurance (NHI) Kuomintang (KMT) ruled Taiwan under Marshall Law 50% health coverage under multiple separate social health funds 1995 Democratic Progressive Party (DPP) combined best aspects of systems internationally into National Health Insurance (NHI) with government as sole payer Smart card implemented for electronic efficiency 2001 CHRONOLOGY / BACKGROUND Healthcare is now a right 98% coverage but government plans to invest more on health care for more quality

Taiwan: National Health Insurance (NHI) Health IC Smart Card NHI Physicians -No gatekeepers, no lines -Low physician to patient ratio -Average 2 to 5 minutes per patient -Submit full reports to government daily -No system to regulate clinical issues and public health outbreaks -Fee-for service payment combined with professional fee (PF) system rewards physicians for productivity -Point system gives incentive to perform fewer procedures -1 KB memory -Stores patient history and medication -Pays bill directly and electronically through government -Decreases fraud -Lowest administrative cost in world at 2% Government -Single-party payer -6.23% of GDP to health (vs. 16% in U.S.) = less than $900 U.S. /person -Worried about increasing premiums to upset voters -Now borrowing from banks Patients -70% satisfied with health system -Taxed 4.55% on wages and salaries for health -Workers pay premium split with employers -Poor and veterans fully covered -Free preventative services, annual checkups, maternal care -Upwards of $5 U.S. co-pay/visit -Option to upgrade physician/hospital for additional money -Covered for health, drugs, vision, traditional Chinese, kidney dialysis, inpatient/outpatient, and dental PLAYERS Hospitals -Can sell drugs at prices much above the acquisition cost = “drug price black hole” -Large percent of hospital income is from drug sales -Problem with overmedication

Taiwan: National Health Insurance (NHI) Good experience with the healthcare system in Taiwan. If you are a citizen, you pay at least $20 USD per month for the insurance. The monthly payment varies depending on your income, but there is a ceiling amount. There are also private hospitals that you can go to but the only extra is a co-pay. Hospital care wise, you have the option of upgrading by paying extra. The norm is 3 to 4 people per room, but you can upgrade to two or single rooms for extra money. They use the insurance card where the med staff type in the insurance card number (everything is computerized ) and get your entire health history. No papers. Anyone can see any doctor anywhere in Taiwan. If you're really poor or are 65 and over, the government gives you certain amount of money to live per month and you can use part of it to pay the $20/month. If you have Taiwanese citizenship but live abroad ( i.e., US) and make no money in Taiwan, you can enter into the system and pay $20 minimum. This begs the question: Is the number of underinsured in the U.S. really misleading? Are many immigrants going back to their country of origin for health care in this manner? Taiwanese citizen living in U.S.: Source: Wikipedia ^ Source: Lee, Ming-Liang (2001-05-14). " Health Care in Taiwan - Past, Present and Future " in 54th World Health Assembly .. EXPERIENCES Before NHI (~1906) After NHI Life Expectancy M: 39 years; F: 43 years M: 72 years; F: 78 years Infant Mortality 84.1 per 1,000 live births 6.14 per 1,000 live births Maternal Mortality 7.6 per 1,000 live births 0.9 per 1,000 live births

Good experience with the healthcare system in Taiwan.

If you are a citizen, you pay at least $20 USD per month for the insurance. The monthly payment varies depending on your income, but there is a ceiling amount.

There are also private hospitals that you can go to but the only extra is a co-pay. Hospital care wise, you have the option of upgrading by paying extra. The norm is 3 to 4 people per room, but you can upgrade to two or single rooms for extra money.

They use the insurance card where the med staff type in the insurance card number (everything is computerized ) and get your entire health history. No papers.

Anyone can see any doctor anywhere in Taiwan. If you're really poor or are 65 and over, the government gives you certain amount of money to live per month and you can use part of it to pay the $20/month.

If you have Taiwanese citizenship but live abroad ( i.e., US) and make no money in Taiwan, you can enter into the system and pay $20 minimum. This begs the question: Is the number of underinsured in the U.S. really misleading? Are many immigrants going back to their country of origin for health care in this manner?

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