Taiwan’s NHI program
Taiwan established universal national health insurance in 1995.
Currently, 99.6% of the population, about 23 million people, is enrolled in the NHI program.
Taiwan’s NHI program is a single-payer system, and has a large single risk pool, cross-subsidization among diverse groups with not only different socioeconomic status but also different health status.
Studies show that the premium contribution compared to the health resources utilized are favorable to the low and middle-low income classes.
Having a single-payer system is the main reason for our efficient services and also the low prices for health care we can achieve. Private delivery and highly competitive providers enable us to have efficient health services.
The NHI Administration’s contract with 100% of the hospitals and 93.5% of the private practitioners enable the insured to have an easy and equal access to health services.
A single insurance administration also has the benefit of a very low administrative cost, which was only 1.15 percent of total NHI spending in 2012.
Although there is no choice of insurers, people enjoy complete free choice of providers. Providers in Taiwan must be mindful of patients’ demands to stay competitive.
The NHI Administration set a uniform national fee schedule for all the providers. Price competition is limited to those services not covered by the NHI program. It is quality competition in nature, not price competition; but it certainly is competition.
Furthermore, the administration of the single-payer system is simple, as there is only one set of claim forms, clinical protocols, quality indicators, fee schedule, etc. The administration costs of hospitals are also much lower than those of a multi-insurer system.
The NHI is the most successful public policy in Taiwan.
The general public has been very satisfied with the NHI. One reason for the high satisfaction is that premium and co-payment rates are low.
Easy accessibility is another reason. Free choice of providers is the key to the easy and equal access of health care.
Basically, there are no waiting list at all except for a few well-known medical centers and well-known doctors.
We solve the problems of rationing by provider competition and efficient services.
Our health performance, e.g. life expectancy, infant mortality and maternal mortality, are better than U.S., although we spent only one-quarter of USD (PPP) in health expenditure.
Before NHI, life expectancy increased 1.8 years from 1986 to 1996, and after NHI, it improved 2.9 years from 1996 to 2006. Studies show that life expectancy improved more for low-ranked health classes.
All providers submit claims electronically based on the patient records they keep, we can do very detailed profiling of both patients and providers.
We are on the way to develop cross-system EMRs, and expect to accomplish a complete life-time e-record system within a few years.
下一則： What the U.S. Health Care System Can Learn from other Countries