Health care in Taiwan
Jonathan Adams May 30, 2010
1 / 100
The airline tickets
• When they get so sick and need to see a doctor, they head for O’Hare and hop a plane for a 20-hour, cross-Pacific trip to Taiwan.
• “The airline tickets are less expensive than getting treated in the U.S.”
2 / 100
Ninety-nine percent covered
• Ninety-nine percent of Taiwan’s 23 million population is covered; in the U.S., more than 45 million people remain uninsured.
• The administrative costs of Taiwan’s system are a meager 1.5%, versus 20 to 30 percent for many U.S.
insurance companies.
3 / 100
Single-player plans
One misconception
• One misconception is that single-payer plan eliminate free competition
• That’s only true for the health insurance market, where the government becomes the dominant or only player
• Health providers, on the other hand, work in a crowded market of both public and private facilities that compete for patients
4 / 100
Hamburger
• It’s like a town of a hundred hamburger joints, where the price of a hamburger is set at $1 —the restaurants would compete for customers based on how juicy, tasty and big their burgers are.
5 / 100
Revenues
• Revenues from Taiwan’s plan come from a combination of individual payroll deductions, employer and government contributions
• With additional funds coming from a “sin tax” on cigarette sales
6 / 100
Privacy
• Every participant gets a “smart card” that contains their basic medical data. When swiped along with a doctor’s and hospital’s card, the smart card accesses a unified, national database
• Americans’ privacy concerns would likely prevent anything similar being adopted in the U.S.—certainly, not on a national scale.
7 / 100
Room for improvement
Overused
• With co-pays so low, many Taiwanese—particularly the elderly—go see a doctor for every minor ache and pain
• “Where’s Old Mr. Lin?”
• “He couldn’t make it today, he’s sick.”
• People jam popular, university-run hospitals where they think they can get the best care
8 / 100
Underfunded
• The government has tried to raise co-pays at popular urban hospitals to encourage more use of local clinics, butto little effect
• A standard visit is less than 5 minutes in length. “In these brief visits, the physician’s focus is on treating symptoms and prescribing medications, not listening to patients,”
9 / 100
Financial security
• One key achievement is financial security, especially for the unemployed or poor, who would otherwise be
“catastrophically hit” if they had major diseases or health issues
10 / 100
A window of opportunity
How did Taiwan get there?
• The politics of health care
• Before 1995, those who did received health insurance through a patchwork of insurance plans that tacked on health coverage as an added benefit, usually for government employees or workers at state-run firms
11 / 100
How did Taiwan get there?
• Taiwan’s authoritarian KMT, rammed the health care reform plan through ahead of the island’s first direct presidential election in 1996
• Contrast that to the politics in the US, where support for any health care reform could cause a lawmaker to lose mucho campaign dollars from big insurance companies and drug firms, ... from elderly Medicare recipients who fear any change to their benefits
12 / 100
Attitudes toward government
• “Throughout Chinese history, one of our founding doctrines, [Confucianism] says the government has to take care of the people”
• This has bred fundamentally different attitudes toward government
• “The government is viewed as a paternalistic figure, ...
People look to the government for help,”
13 / 100
Listen to Taiwan
• “It’s easier to control costs with a single-payer plan, and the island’s system offers patients their choice of doctors and free-market provision of care”
• Fifteen years later, maybe it would be a good idea for America to listen to Taiwan
14 / 100
