21 March 2018
Taiwan’s National Health Insurance advances WHO goal of universal coverage
Taiwan’s National Health Insurance program is a global benchmark in universal coverage and offers valuable lessons in
delivering high-quality, cost-effective medical care for all, according to Minister of Health and Welfare Chen
Shih-chung.
In an interview with Taiwan Today in the run-up to the 23rd anniversary of the NHI’s establishment March 1, Chen said
Taiwan’s wealth of experience can help the World Health Organization realize its top priority as specified by WHO
Director-General Tedros Adhanom of achieving universal health care around the world. Taiwan would welcome the
opportunity to share its expertise by participating in the 71st World Health Assembly, the decision-making body of the
WHO, May 21-26 in Geneva, he added.
“The NHI is based on the principle of leaving no one behind. All citizens and foreign residents are enrolled,” Chen
said, adding that Taiwan has consistently expanded coverage over the years.
In 2013, all 60,000 prison inmates were added to the program. A further measure broadening coverage was implemented in
December 2017 when babies born in Taiwan to foreign residents—previously only eligible to join at six months old—were
included at birth. Chen said this demonstrates Taiwan’s respect for health care as a fundamental human right.
NHI users can access a wide range of services spanning Western medicine, dental care and traditional Chinese treatments
at affordable prices. To ensure fairness, premiums are set as a proportion of an individual’s income.
This figure is currently 4.69 percent for employees, who pay 30 percent of this amount, with their employers
contributing 60 percent and the government the remainder. In a survey conducted by the Ministry of Health and Welfare
last year, 85 percent of respondents expressed satisfaction with the NHI.
“The NHI Administration under the MOHW is the single payer for all medical services. This arrangement ensures high
levels of efficiency by significantly reducing administrative spending,” Chen said.
In 2017, these expenses accounted for 0.9 percent of total outlays. According to the minister, this was the lowest in
the world.
In addition to controlling costs, the NHI has led to continuous improvements in public health through the regular
introduction of cutting-edge medications and treatments, Chen said. Recent initiatives include the addition in January
2017 of newly developed antiviral hepatitis C drugs for patients with advanced forms of the disease, he added.
This move is expected to bolster public well-being as the illness, a major cause of liver cancer, is estimated to affect
up to 600,000 people, according to Taiwan nonprofit Liver Disease Prevention and Treatment Research Foundation.
In 2017, the NHIA allocated NT$2.4 billion (US$82 million) for the expensive, highly effective oral hepatitis C
medications, providing the drugs to some 9,300 people. This year, a total of NT$4.25 billion has been earmarked with the
goal of helping an additional 17,000 patients.
“This is money well spent. Dealing with the disease now will save a lot in the long term by preventing more serious
health conditions,” Chen said.
Since the launch of the NHI, average life expectancy in Taiwan has risen from 74.5 to 80.2 years. This increase has
drawn global recognition, with more than 50 foreign delegations visiting to learn about the program last year alone,
Chen said.
According to the minister, in light of Taiwan’s rapidly aging population and the pressure this will place on medical
care spending, the government is moving to ensure the long-term financial viability of the system.
A major step in this regard came in 2013 with the launch of the second-generation NHI. Among other changes, the
government boosted revenue by levying a 2 percent charge—lowered to 1.91 percent in 2016—on supplementary income such as
bonuses and stock earnings. This measure expanded the program’s premium base while making contributions more reflective
of an individual’s full income.
According to Chen, another round of reforms will be launched in the next three to four years with the aim of further
boosting overall efficiency and ensuring fairness in premium contributions.
“While no national health insurance program in the world is perfect, Taiwan’s model has been a resounding success and
can serve as a reference for other nations,” he said. “Through technical meetings at the WHA, Taiwan can learn from
other countries and give back by sharing its health care expertise.”
END