By Chiang Been Huang
Atlanta Journal Constitution, May 27, 2015
National health insurance has long been an issue of controversy among Americans. Even now, with Obamacare in place, Georgians and other U.S. citizens are divided as to its efficacy. Perhaps Taiwan’s experience with national health care can offer some perspective.
There was controversy when, in 2013, Georgia refused to expand the Medicaid program under the Affordable Care Act. The expansion would have provided an estimated 650,000 low-income Georgians with health coverage, with most of the funding provided by the federal government.
Taiwan’s single-payer National Health Insurance system enrolls more than 99 percent of the population, and around 93 percent of the country’s health care providers participate. Basic premiums, shared among the insured, employers and government, are calculated based on monthly salaries and a set premium scale.
Disadvantaged persons can have their premiums and co-payments subsidized or waived, if necessary. As the NHI has achieved universal coverage at an affordable cost, health care is not a financial burden for the public. These factors contribute to a system satisfaction rate of about 80 percent. In Georgia, by contrast, taxpayers bear the cost of care for the uninsured in public hospitals and emergency rooms.
Yet since its launch in 1995, the NHI has faced funding challenges. Rising user demand led to budgetary shortfalls, spurring the government to implement systemwide fiscal and structural reforms. In 2013, the government levied a 2 percent supplementary premium on capital gains and unearned income, a measure that contributed to the NHI’s newfound financial strength.
Another step in improving universal care was the adoption of the latest information technologies. The integrated circuit card, issued to all system users, functions as a link between patients and health care providers, giving quick, secure access to medical records. The smart card is also valuable in managing the spread of highly communicable diseases, such as SARS.
As time is of the essence when dealing with medical issues, in 2013, the NHI established PharmaCloud, a cloud-based database of patient pharmaceutical records accessible to health care providers. This undertaking has minimized the incidence of script duplication and over-prescription, as well as the risk of harmful drug interactions.
Buoyed by the cost and efficiency benefits of PharmaCloud, the NHI launched My Health Bank in 2014. In less than 10 minutes, users can access their full medical data from the past year. Designers hope easy access to personal records will help users develop an appreciation of healthier lifestyles.
An automated system for processing hospital claims and reimbursements contributes to the NHI’s administration costs of 1.07 percent of medical expenditures, the lowest in the world. The sizable database of claims, which boasts leading-edge, internationally certified information security, also allows the NHI to analyze trends and generate statistics.
Going forward, decreasing birth rates and rapidly aging populations are the order of the day. Taiwan is no exception to these global trends, and its shrinking youth demographic will have to shoulder a greater financial burden. When estimating future demand for health care, the factor of aging must be taken into account.
Looking at ways to improve public health and slow the rate of aging are two of the most important challenges facing the NHI in the 21st century and beyond.
Taiwan is committed to national and global good health. We are proud of our health care system, and we wish much future success to the Affordable Care Act and good health to the Georgians who subscribe to it.
Chiang Been Huang is minister of health and welfare for the Republic of China, Taiwan.
This article appeared in the print edition under the title “Insights from a single-payer system.”