Medi-debate: Can Taiwan's system offer insights?

17 Jan 2008, Today

Question

Name of the Person: Liu I-Chun

Healthcare there is more affordable, waiting time short

HEALTHCARE costs have been hotly debated recently. Having lived in Taipei for the past two-and-a-half years, I would like to share my positive experience with the Taiwanese system.

Taiwan's healthcare is generally more affordable than Singapore's due to the National Health Insurance (NHI) scheme.

With the NHI, seeing a senior eye specialist at the National Taiwan University Hospital, for example, costs about half the total bill of $44, complete with diagnostic tests and consultation.

Seeing a dentist for routine scaling and polishing is fully covered by the NHI, with the patient paying just $5 for registration. Even a specialist dentist who is not under the NHI scheme charges less than $25 for a consultation, electric nerve test and X-rays.

Cost savings aside, making medical appointments is also a breeze. It can be done easily via the Internet, where doctors' schedules are posted and appointments can be made up to 30 days in advance.

One can even see a specialist (no referrals needed) on the day itself if there are last-minute appointment cancellations.

Seeing a specialist within a week is not a problem at all. Waiting time is much shorter in Taiwan as there are so many hospitals that are well staffed with doctors. One is given a number (instead of a specific time slot) so there are fewer complaints about lengthy waits.

I would like to share two articles that describe the Taiwan healthcare system.

While there are pros and cons to any system (the NHI is running at a deficit at current contribution and usage levels), there are areas that we can learn from each other and improve.

According to "Taiwan gets healthy", The Guardian (Oct 7, 2007): "In 1995, Taiwan, introduced a single-payer healthcare system that delivers universal coverage with free choice of doctors and hospitals and no waiting lists.

"... When the Taiwanese set up the system, more than 40 per cent of the population was uninsured. They are now covered by the NHI scheme — and because of the increased efficiency of the single-payer system, this was done at little or no extra cost.

"... The aim is for the premium income to pay costs, but there is also a tobacco tax surcharge that goes to the NHI, and contributions from the national lottery."

Excerpts from "Healthcare expenditure in Taiwan is not high", The Taipei Times (Dec 31, 2006): "According to this year's World Development Indicators Report published by the World Bank, total health expenditures as a proportion of gross domestic product (GDP) were 4.6 per cent in low-income nations, 6 per cent in middle-income nations and 11.2 per cent in high-income nations. Taiwan is more or less a high-income nation, but according to Department of Health statistics, the nation spends only 6.2 per cent of GDP on health services. This means that there should be room for increased outlays.

"... Generally speaking, Taiwanese pay less for healthcare than people in other countries. The public should feel that their healthcare services are cheaper than other nations, and this should be a source of some satisfaction …"

According to Health Minister Mr Khaw Boon Wan, Singapore now spends about 4 per cent of GDP on healthcare cost, which puts us in the category of a "low-income nation" despite the wealth that we generate.

I feel that the authorities can do more to reduce the burden of cost on the public.

Reply

Reply from MOH

Taiwanese Healthcare System Not All Rosy

In "Healthcare there is more affordable, waiting time short" (TODAY, Jan 15), Ms Liu I-Chun shared her positive experience with the healthcare system in Taiwan. Indeed, all healthcare systems can learn from each other as no system is perfect, and each system has its strengths and weaknesses.

The healthcare system in Taiwan is not without problems. Its National Health Insurance (NHI) scheme has been in deficit, with expenditure exceeding revenue since 1998. In 2005, the government had to inject an emergency package of NT$11 billion to provide temporary relief. Recent numbers by the Bureau of National Health Insurance showed that NHI was still incurring a loss.

Over-consumption appears to be a factor. This is typical of comprehensive medical insurance schemes where patients do not have to pay much at the time of use. Low premiums and low usage fees are of course welcomed by patients, but the pleasant outcome is not sustainable. As insurers need to cover their cost, over-consumption will rapidly translate into higher premiums for all. The alternative is curtailment of benefits and payouts. This is the reality that all healthcare systems have to face.

Keeping healthcare cost low is not too difficult, but maintaining a high standard at the same time, against rising public expectation and costly medical advances, is the real challenge. It requires careful management of resources and proper incentive systems to reduce abuses. Any "free lunch" in healthcare is ultimately paid for by the people.