Health care justice: What can the United States learn from Taiwan?

Until 1995, Taiwan had a fragmented health insurance system that covered only 55% of its population, whereas the remainder 45% was unable to meet its most basic health care needs. Yet after a planning effort of about half a decade, and a strong, explicit commitment to health care equity on the part of government officials and the Taiwanese people, the country managed to replace their non-system with a national health insurance scheme that provides universal and comprehensive medical care according to medical need and not ability to pay. Further, the percentage of GDP spent by the system is substantially lower than the OECD average (~7% vs. 10%), its administrative costs are minuscule (under 2%), and waiting lists for medically necessary services are all but non existent. There is also evidence that since the system's implementation Taiwan has seen an important decrease in mortality for treatable conditions together with an increase in life expectancy. What explains the Taiwanese apparent miracle? Drawing from close to five years of teaching about Taiwan's health care system and personal experience teaching health care policy to graduate students in this island nation, this presentation will provide an overview of the Taiwanese health care system, the political, cultural and social contexts within which it came into being, and its strengths, weaknesses, and prospects. It will also suggest what the United States, plagued by over a century of struggles and failures to achieve healthcare justice, can learn from the Taiwanese model and experience.