Can US learn from Taiwan’s health insurance system?

On May 15, the Silicon Valley Taiwanese American Industrial Technology Association (TAITA-SV) held its annual conference in San Jose, California. The association chose to focus this year’s theme on “Health Care Reform – Changes and Opportunities” by inviting speakers knowledgeable about health care reforms in Taiwan and the United States. Dr. Yeh Ching-chuan, the founding CEO of the Bureau of National Health Insurance (NHI), Taiwan’s universal health care system, noted that Taiwan spends one seventh of what the US spends on health care but with the same or better results.

Founded in 1995, the NHI is about to undergo a second-generation of reforms to combat rising costs. The new system will be in place by 2012 and will alter the premium structure currently in place. Before NHI, nine million of Taiwan’s twenty-two million residents were uninsured. Now, 99 percent of the population is insured. The program has consistently earned high satisfaction ratings, ranging from 60 to 80 percent during the last 15 years. It has helped to increase Taiwan’s life expectancy by four years and improved the health of Taiwan’s less fortunate.

Taiwan’s single-payer system is run by the government with mandatory enrollment. The premiums come from employers and the government, with the user also paying a share. The single payer system fosters social equity by protecting low income groups. Moreover, by pooling general administrative costs it also substantially reduces tax costs. As an example, if the US health care administration could be as efficient as Taiwan’s the US would save US$110 billion and cover the 50 million Americans currently without health insurance.

According to Yeh, the virtue of the US system lies in its research and development, which is two to five years ahead of Taiwan’s. This has enabled the US to more quickly adopt new drugs and technology. The US also has excellent medical education. Even so, health care should be an universal right and not a luxury. Taiwan’s system offers uniform benefits and equal access, but also reduces costs and improves efficiency, for instance by using a single database, containing costs and providing a higher level of quality control.

In conclusion, Yeh said the US system is marked by “inefficient insurance,” whereas Canada’s system is marked by “inefficient delivery.” Taiwan’s system is a matter of “inefficient government,” but out of the three, he considers it the better alternative.