190290 Accomplishments and challenges of Taiwan's national health insurance program

Monday, October 27, 2008: 12:30 PM

Michael S. Chen, PhD , Bureau of National Health Insurance, Taiwan, Taipei, Taiwan
Taiwan's NHI has won reputation worldwide, yet it was not born with a silver spoon in the mouth. Instead, many predicted that its days were numbered right at its birth. Going against all odds, 13 years passed, the NHI is still kicking and alive, providing quality medical care to virtually all the population, nationals and foreigners, at a very low cost. Yes, there are some persistent financial problems, but no one now would foretell its demise in any near future.

We summarize its secret of success as follows:

1. A single-payer system is the largest risk pool that a nation can ever have, which carries the capacity of risk pooling to the maximum, and ensures that every one is insurable.

2. A single-payer system also serves as a platform on which all the resources can be put together for effective cross-subsidization at a very low administrative cost.

3. A single-payer is a monopolistic buyer which will force the medical profession to cooperation for the good of the people.

4. A single-payer system generates a single data warehouse, with which state-of-the-art managerial capabilities can be built for efficient resource allocation.

5. Commitment at the personal level induced action-oriented “implicit knowledge” which effectively deals with challenges facing the system on daily basis.

6. A very critical media forced the system as well as the medical institutions to be responsive to the public.

A “second generation” legislation is being proposed to address the financial problems by putting the premium on a broader basis.

Learning Objectives:
1. Taking inventory on how Taiwan could pull together such a health plan that cuts cross all the boundaries to serve all the population, and demonstrating how a nation can overcome their initial obstacle in making a similar program; 2. Tracing the “secret of success” for Taiwan’s NHI, and illustrating the relevance of Taiwan’s experience for other nations; 3. Identifying built-in problems with a single-payer system that need to be address for its survival. 4. Emphasizing the importance of the “praxis” over the “theory” in creating a durable program.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the vice president of the Bureau of National Health Insurance which is the organization in charge of the National Insurance Program in Taiwan.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.