Toward universal health coverage: Taiwan’s experience

 05-28-2012  By Chiu Wen-taThe World Health Organization (WHO) attaches great importance to the establishment of health care systems. Its 2010 World Health Report focused on universal health care, and the 2012 World Health Assembly has chosen for its theme "Toward Universal Coverage" ― indicating global recognition of the need to establish sound and comprehensive health care systems.Taiwan's National Health Insurance (NHI) program, launched 18 years ago, has received affirmation at home and abroad. The American Broadcasting Company (ABC) and the Public Broadcasting Service (PBS) have separately produced programming highlighting the NHI. This year, Cable News Network (CNN) aired a report on the medical and health care systems of Taiwan, the U.K. and Switzerland, lauding Taiwan's success with its program. In 2011, delegations from over 50 countries visited Taiwan to study its universal health insurance program.In the days before the NHI was established, over 40 percent of the nation's citizens had no health insurance. Following seven years in the planning stage, the NHI program was introduced as a single-payer plan on March 1, 1995 as a form of self-financed social insurance. Premiums are shared among the insured, the insured's employer and the government. About 99.6 percent of Taiwan's population is covered by the NHI.The program allows for all insured persons to access comprehensive medical service. Among services covered are inpatient and outpatient care, Chinese herbal medicine, dental services, childbirth, rehabilitation therapy, home care and care for chronic psychotic patients. All insured persons have the right to immediate medical treatment at any of the over 25,000 clinics and institutions in Taiwan.More than a decade after the NHI program came into force; the government conducted a review of the system and proposed a "second-generation" system to institute a fairer payment scheme by levying a 2-percent supplementary premium on non-payroll income and individual capital gains. When the new system takes effect in 2013, basic premium rates will be reduced to ease the financial burden on the working class, ensuring greater fairness and strengthening social justice.The greatest factor behind the NHI's success is Taiwan's dedicated medical professionals, who have earned our deepest appreciation and greatest respect for their commitment to the public.For years, Taiwan has focused on providing affordable, accessible and effective medical service based on a fair payment scheme. It now faces another problem ― that of medical staff shortages and work overload ― and is making an effort to attract more people to the medical profession and improve working conditions.Taiwan's health insurance scheme has successfully enrolled nearly the whole population, is of a high quality, allows for convenience in seeking medical care, and has kept a lid on costs. Collective medical costs for the entire citizenry under the NHI amount to just 6.9 percent of GDP. Administrative costs take up just 1.5 percent of all outlays thanks to a sound information technology network. Moreover, as of the end of 2011, 3.07 million people had benefited from insurance premium subsidy programs. As the most vulnerable in society are covered by the insurance scheme, the link between illness and poverty has thus been broken. The NHI is one of Taiwan's most successful public projects in history, with a public satisfaction rate of 88.6 percent.For its NHI system and many other public health achievements, Taiwan has earned affirmation from countries worldwide. Since 2009, it has been invited to be an observer at the annual World Health Assembly (WHA), opening up new opportunities for broader and deeper participation in international cooperation on health-related issues. Taiwan is also eager to help raise global health standards by sharing its experiences through the WHO platform.Unfortunately, however, though Taiwan has gained WHA observer status, no substantial progress regarding its further participation in the WHO has been seen. In May 2011, a confidential WHO memo came to light indicating that Taiwan had been downgraded in status and made subject to many restrictions. The people of Taiwan and many in other nations have voiced dissatisfaction and grave concern over the situation. Taiwan has also expressed time and time again to the WHO Secretariat its protest at such treatment.Here, I call on the international community to support us. I urge the WHO Secretariat again to respond to our request that Taiwan's participation in WHO affairs be expanded from attendance at the WHA to inclusion in other WHO meetings, mechanisms and activities. This will ensure Taiwan's meaningful, dignified participation in the World Health Organization.The writer is Taiwan's minister of health.