Taiwan’s minister speaks at int’l healthcare meeting

In speaking to attendees at the Healthcare in Asia 2010 Forum, Taiwan’s Health Minister Yaung Chih-liang said there are four kinds of healthcare system in the world, each one with its merits and disadvantages. The March 30th meeting of Asian healthcare leaders took place in Singapore and was sponsored by the Economist Intelligence Unit (EIU).

The Central News Agency reported that Yaung, who is promoting the second generation of healthcare insurance in Taiwan, was invited to speak at a closed session of the forum to discuss the problems associated with health insurance that Asian governments are facing. His remarks struck a chord with the attending representatives who wanted to know more about Taiwan’s successful experience.

Four types of healthcare systems

Yaung said among the four healthcare systems are 1) a national health service (NHS), adopted in the United Kingdom and the countries of the British Commonwealth, which allocates a certain percentage of tax revenues as a national health insurance system; 2) the social insurance system, such as the one in Taiwan, 3) a mix of patients paying their fees and private insurance systems; and 4) a combination of the above-mentioned three systems.

In describing the first example, he likened it to the UK’s NHS system. It is a type of single-payer public funded healthcare system financed through taxation from the government budget. Everyone receives the same level of coverage regardless of their ability to pay, their level of taxation, or risk factors. It is a very fair system and without moral problems, but the drawback is that as the health insurance budget is fixed, hospitals and doctors get fixed incomes. So there is no incentive for them to see more patients, and waiting lists can get very long, resulting in the government’s inability to meet patient demands.

With regard to the third type, Yaung said, this system is based on patients paying their own fees, but people with low incomes cannot afford to do so and the government does not want to take care of their medical needs either. Developed countries that have a private insurance system, such as in the US, end up creating a big medical gap between the rich and the poor.

Taiwan’s social insurance system

Yaung said that Taiwan’s social insurance system is based on the philosophy that government is responsible for the people's health, and it takes into account the healthcare of the low-income class, which is why Taiwan adopted this system.

However, a shortcoming of this system is that it gives rise to “civic failure,” since the people have the government's healthcare; they are not as pro-active in taking care of themselves. This wastes medical resources, resulting in rising healthcare costs. But Yaung emphasized that Taiwan's healthcare system has a 70-plus percent satisfaction rating, meaning that the system clearly has its merits.

Not a one-size-fits-all model

Asked to comment on Singapore's 3M structure (Medisave, Medishield and Medifund), Yaung said that Singapore's system is basically one of compulsory saving accounts, that is, to take money from the people, equivalent to the concept of patients paying their responsibility without the government’s help. This system may not work in many other countries, because the system forces the people to maintain their own healthcare savings.

Those people above the poverty line, but not qualifying for social benefits, still struggle to meet the necessary healthcare costs. They have to dedicate part of their already low salaries toward health savings, which makes their lives more difficult. This is in violation of the spirit of social welfare and social care.

Many participants, including representatives of Indonesia and Malaysia, agreed that the Singaporean system works in Singapore, but not necessarily in other countries. China once tried that system, but it failed. According to Central News Agency, representatives of Indonesia, Malaysia, and Australia expressed a wish to learn from Taiwan's national healthcare system.