Flag of Taiwan
The two previous articles explored the single-payer health care systems in both Canada and Britain. This article will focus on Taiwan, which has also instituted a national health care scheme, but rather than focusing on taxation, citizens pay into a national health insurance fund that is tightly controlled through government regulation.
Read: A history of health care in the U.S.
Read: Distortions in the public debate on health care
Read: The Patients’ Choice Act
Read: The Affordable Health Choices Act
Read: The Public Option
Read: The Canadian health care system
Read: The British health care system
Taiwan
As recent as 1995, more than 40 percent of the population in Taiwan was uninsured. With the creation of their universal health care system, more than 96 percent are now insured with no overall increase in the cost, and dramatically improved health outcomes – particularly among the poor. The Taiwanese boast of integrating the best features of health care systems around the world. Even though there are only 1.4 physicians for every 1,000 patients, Taiwan has not experienced the longer waiting lines that Canada and Britain have.
Unlike the programs of both Canada and Britain, in which premiums are paid directly to the government, and then distributed to regional administrators; employers, individuals, and the government in Taiwan pay compulsory, income-based premiums to the National Health Insurance (NHI) plan. In the same spirit of compulsory premiums, which are intended to make patients more conscientious of the health services they consume, the Taiwanese also contribute minimal co-pays: 20 percent of drugs up to $6.50, about $7 for outpatient care, and $2 for dental. Individuals seeking care for a major disease, child-birth, or preventive care, and the poor, children and veterans, are exempted from co-pays.
The Bureau of National Insurance (BNHI) operates on a national global budget, which was introduced to contain costs and is determined by the more centralized Department of Health, which negotiates contracts with health care providers on a fee-for-service basis with a uniform pay schedule. A deflation mechanism engages once a service quota is reached, resulting in declining reimbursement rates. For a visual chart of financial and service flows, click here.
Taiwan has the lowest administrative costs in the world at less than 2%. They only spend 6.3% of GDP on health care expenditures, and the average family premium is just $650 per year for a family of four. Contributing to these lower costs is the advanced use of Smart card technology to increase administrative, billing, and provider efficiencies. Every insured Taiwanese has a Smart card with the patients’ history and medications, and which automatically bills the national insurance fund, which has resulted in expedited reimbursements.
Information stored on the Smart card includes: personal information, including the card serial number, date of issue and cardholder’s name, gender, date of birth, ID number, and picture; and NHI-related information, including cardholder status, remarks for catastrophic diseases, number of visits and admissions, use of NHI health prevention programs, cardholder’s premium records, accumulated medical expenditure records and amount of cost-sharing.
Transitioning to the Smart card system has resulted in hospitals and clinics uploading electronic records daily to the BNHI. After every six patient visits, card information is uploaded online for data analysis, audit, and authentication.
While managing to achieve similar – if not better results – than both Canada and Britain, at a lesser cost, the Taiwanese system is not without its flaws. It suffers from false reimbursement claims, in which provider’s bill for more expensive procedures when administering less costly care. There is a problem with excessive pharmaceutical use. The system is somewhat fragmented, because private physicians can practice, but have no hospital admitting privileges, resulting in duplicative facilities and equipment.
There is no regulation providing for the systematic reporting of clinical performance, patient outcomes, or adverse events. The incentive framework encourages physicians to gravitate toward specialties with a higher reimbursement rate. The Taiwanese are able to choose freely among health providers, and irrespective of the out-of-pocket expenses, still tend to over-consume as a result of seeking unnecessary care, or care that does not require a specialist. Taiwan now faces budget shortfalls, a rising national debt, and questions about fiscal sustainability.
To end on a positive note, the country could increase its spending by 25 percent, and still consume only half of what the U.S. consumes, but similar to America, proposals to increase revenues in Taiwan are politically unpopular.
The next several articles will focus on other systems that provide universal coverage through what are commonly referred to as the Bismarck model. Named after the Prussian Chancellor Otto von Bismarck, these systems of health care have been measurably successful in implementing models that mix the public and private sectors.
The next article in this series will explore Germany - the country from which the Bismarck model arose.
Read: The German health care system
To receive notification when the next article of the series on health care reform is published, click on the “Subscribe” link below.
*If you would like to submit a health care story, with the possibility of seeing it published here, please send me an email message at jennyk1981@gmail.com.
Copyright ©2009 Jenny Kakasuleff
For more info:
Five Capitalist Democracies & How They Do It
Taiwan Takes Fast Track to Universal Health Care
Learning From Taiwan: Experience With Universal Health Insurance
Taiwan Health Care Reform Foundation: Health care in Taiwan
Health Care Financing Policies of Canada, the United Kingdom, and Taiwan
Comments
Wow the average family of four in
Taiwan pay less per year than my husband and I pay per MONTH for health insurance. And they have dental insurance! Why can't we have that? I just want a choice. And I'd love to be able to go to the dentist.
This turn around in 14 years is truly amazing. Again, there are flaws, but this will be so with any system, and they are no where near the flaws of our presently catastrophic system.
Get over it! After Obumble's incoherent hour long stammering and stuttering act last night, you're doing nothing but spewing empty rhetoric. Can you imagine the quality of physicians you would get under Obamacare, since physicians salaries would obviously have to be cut to accomodate Obumble's plan? More talented people would obviously choose other ways to make a living, and oh well you might wind up with someone like Dr. Sotomayor as your physician.
Hook: I would not consider pages of research, statistics, and facts, rhetoric. I've taught readers more about health care through this blog than FOX News has taught them since they've been on the air.
Your perceptions are "obviously" incorrect, since patient satisfaction is extremely high in the three countries I've referenced - meaning most are happy with the quality of care they are receiving. A majority here support health care reform.
Perhaps the only motivation in life that you have is the dollar, but there are other incentives that bring physicians into the field of medicine. Granted, physicians make less in universal countries relative to their American counterparts - but they also do not have medical school loans to pay off or back-breaking medical malpractice insurance - which makes a huge difference in pay.
You are not interested in a serious discussion on health care, so take your vitriol to WorldNutDaily where you can be at home with the other obstructionists.
There are so many problems with ObamaCare....
"Senate Majority Leader Harry Reid, D-Nev., delivered the official word on what had been expected for weeks, saying, "It's better to have a product based on quality and thoughtfulness rather than try to jam something through.""
STILL no YES or NO from Jenny on the long standing question!?
After racking my cerebellum and medulla oblongata with other constituents in the medical field, I completely agree with Dr. Hook's diagnosis that Obamacare will remain in a persistent vegetative state.
Jenny says: "I've taught readers more about health care through this blog than FOX News has taught them since they've been on the air."
That is the funniest thing I have read in days!
Thanks for the chuckle.
At LEAST Fox is "fair and balanced".
At LEAST Fox is "fair and balanced".
AND Fox has the TOP 10 cable news programs IN THE TOP 10, they own them all!
Rush Limbaugh couldn't hold Rachel Maddow's jockstrap.
"That is the funniest thing I have read in days!"
Apparently, you missed the birther thread. Oh, no wait, that's right; you're just illiterate.
FOX being fair and balanced is even more laughable. Even their own "anchors" admit they are "commentators, not fact-checkers." I guess you missed that episode. But when you have no reading comprehension, I suppose you have no choice but to rely on the rhetorical gems bestowed by Hannity and Limbaugh.
I hear Hooked on Phonics is a great program.
"Jenny says: that's right; you're just illiterate. "
More unbecoming words from a woman.
More ad hominem attacks from a lieberal.
What else do we expect? Both are signs of a person who has lost the argument and resorts to such tactics. How Alinsky of you.
I hear there are drugs to prevent bitchieness too.
Que: For someone who is unable to determine after thoroughly reading all 60 of my articles, whether or not I believe the executive or legislative branch should play a part in health care reform, I have no other conclusion to draw.
I know it's frustrating when those darn liberals keep forcing you to click on their articles, but then refuse to read them for you too. Do you need help to wipe your a** too?
There are also drugs for your condition - I think lithium will help with all the voices in your head.
I'm afraid I have to concur with Dr. Hook and Jethro on health care reform. Many of my cohorts feel we should not emulate the health care of third world countries.
Yeah like we want the government and Obumble rationalizing third-world quality health care.
"We have the best health care system in the world. Most Americans live within an hour's drive of a world-class medical facility filled with expertly trained individuals and state-of-the-art technology delivering medical miracles every day.
But today, as our government attempts an overhaul that will significantly restructure and restrict the way in which doctors provide care to their patients, the health care system that so many Americans depend on is at risk. Currently, more than 250 million Americans have health insurance and the vast majority of them are satisfied with the coverage they have and the doctors they see."
Why, then, is government trying to upend the entire medical system? The government claims the reason is cost and quality. But the government plan increases the cost and gives a dystopic future of rules that stifle innovation and diminish quality through long waits for care and rationing...."
"...The AMA's tacit endorsement of the public option in H.R. 3200 is in direct conflict with its long-standing policy, approved by the AMA House of Delegates, of reducing government interference with the work that goes on in a doctor's office or an operating room and is antithetical to what most doctors in America support. A government-controlled health care system, as we've seen in countries around the world, will lead to patients losing their current coverage and choice of doctor, long waiting lines for care, and a government formula to ration medical treatments.
In a land founded on liberty, it is wrong that the federal government would dictate to doctors what medical treatments can, or worse, cannot be given to their patients. Unfortunately, in nations around the world, this is already happening."
Take, for example, these comments from the then-chairman of the British Medical Association in 2003 as he characterized his nation's government-controlled health care system as "the stifling of innovation by excessive, intrusive audit ... the shackling of doctors by prescribing guidelines, referral guidelines and protocols ... the suffocation of professional responsibility by target-setting and production line values that leave little room for the professional judgment of individual doctors or the needs of individual patients."
At some point in our lives, we're all patients, and the way to strengthen our system, to control both cost and quality, is to empower the patient. If the federal government is allowed to expand its role in medicine, our country will see the long waiting lines for care, patients will lose trust in their doctors, and the medical discovery and innovation that has saved and enhanced lives across the country will end."
"That's something patients -- and doctors -- should not allow to happen.
Dr. Daniel H. Johnson Jr., Dr. Donald J. Palmisano and Dr. William G. Plested III, are all former presidents of the American Medical Association."
I trust Doctors more than I trust Obama, Reid, Pelosi, Kennedy or even ANY elected official in this matter.
Even though Obama told America last night that "Right now doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there.
So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out."
He owes Doctors everywhere an apology. That's shameless.
I have NEVER had a pediatrician who I thought did not have the best interest of my kids in mind.
Are these bad Doctors going to be fired because they broke their Hippocratic Oath?
Or will they be UNIONIZED and not fireable?
www.washingtontimes.com/news/2009/jul/23/cbos-curious-health-care-estimates/
Jenny, I don't know how you put up with these conserviturds. Their only purpose in life seems to be repeating what they hear on the
so Fox and E I b.
I have to admit, it is a lot less time consuming, than doing your own research and actually making a determination all by your self.
Besides, It's unfair to have a battle of wits with an unarmed adversary. They have to be able to respond with witty retorts, even if it's some other persons misguided, witty retort.
Obama's premise is just factually wrong too. The primary care pediatricians don't generally perform the tonsillectomy. So what would the primary benefit financially from its recommendation?
Then its the surgeon and the anesthesiologist etc.
It was just a straw man in the debate.
Much less the slur on so many good Doctors.
So in ONE day Obama denigrates two groups and or individuals, Doctors and police.
What can ya say? Who's group is NEXT?
Judging by " Deej's Dad" spelling, it looks like Bradford is trying to go incognito.
It is over. Obama stated he wants a vote in 2 weeks, and at the earliest per Reid: No Senate health care vote until fall. Tax and Cap will also be delayed in the Senate and won't make it for the 'leaked' EPA report showed the real facts on false claims of man made climate change. The data was from ground locations around the world, Satellite data and was recent vs. the 'staged' data UN had. His poll #'s are dropping fast and as unemployment grows he will become a lame duck. I found two neutral places for a friendly debate and your last remark was that you were too busy. I am busy two and you are afraid to debate me. I would not interupt you in the debate and it would not be personal in any way. Are you game, or are you going to run away again?
Doctor Proctor: Canada is not a third world country. Neither is Britain, Taiwan, Germany, Japan, Italy, the Netherlands, Switzerland, or any of the other industrialized countries with universal health care.
Que: "We have the best health care system in the world." Your source is clearly delusional. Based on what evidence? Because most of us live "within an hour of an expert?" LOL. That's hilarious. It's as if living within an hour matters when you are UNINSURED or UNDERINSURED.
Mike: Clearly, I have not "run away," my page is here at the same URL. I have put forth my side of the debate on health care reform; your turn. Better get to work. You have a lot of catching up to do. I'm not afraid of anyone who doesn't know the difference between too, to, and two.
Just so you know "deej" dad happens to be the father of a solier, who is deployed in afghanisthan. f U
Its nice to get a complete overview of all of our healthcare options. Im not sure why we are bothering to bicker with brainead conservatives. It is what it is, if you want your way, then you have to win elections and earn creibility. You have to bring more to the table than comparing the Presient(seriously, where did your patriotism go?) to a dictator, an call it socialism, or facism, or 1984, or some bizarre anti semetic, conspiracy.
Damn looks like little Jenny and her mark the Bradford can't sleep, up there kinda late kiddies. I suggest eating a tuna fish sandwich heavy on the mayo, drowned by a big ole glass of vitamin D rich milk with 2 oreo cookies about 30 minutes prior to bedtime to cure your insomnia. You see the sugary cookies will accelerate the speed of the trypthophan-loaded sandwich and milk entering through your bloodstream making you drowsy naturally, without having to resort to taking addictive sleeping medications like Lunesta, Ambien etc. This one is on the house kiddies but next time cash only.
I would say Brad was hitting the bottle judging by his incoherent babblings and poor almost illiterate spelling issues, but he's like that sober, certainly not the sharpest knife in the drawer.
Jenny says: "We have the best health care system in the world." Your source is clearly delusional."
DELUSIONAL! These were THREE past PRESIDENTS of the AMERICAN MEDICAL ASSOCIATION!
What is YOUR problem? These were fine and smart enough Doctors to be elected to run the largest medical association in the world!
I know, I know Jenny, any source outer that YOU is worthless right?
I will repost from the "chairman of the British Medical Association" in 2003 as he characterized his nation's government-controlled health care system as
"the stifling of innovation by excessive, intrusive audit ... the shackling of doctors by prescribing guidelines, referral guidelines and protocols ... the suffocation of professional responsibility by target-setting and production line values that leave little room for the professional judgment of individual doctors or the needs of individual patients."
He is an unreliable source too?
Irrationality and Fascism in Government-Regulated Health Care
by Michael S. Rozeff
www.lewrockwell.com/rozeff/rozeff302.html
OUR COUNTDOWN TO FASCIST MEDICINE
By Arthur Caplan, Ph.D msnbc.com contributor
able2know.org/topic/134494-10
Obama’s Health Care Fascism
www.global-elite.org/node/965
THE most divisive President in history.
www.rasmussenreports.com/public_content/politics/obama_administration/daily_presidential_tracking_poll
"Eighty-three percent (83%) of Democrats continue to approve of the President’s performance while 80% of Republicans disapprove."
Dr. Love: I thought one was not supposed to eat before bed?
Que: I don't believe the AMA is an unbiased source of information on the topic. You do? BTW, this president has tried more to appease his political enemies than GWB ever did. You think it's odd for 80% of Americans to support their own party? That's not divisive, but rather, political preference.
I can say with some confidence that this president had more republicans vote for him than GWB had democrats vote for him.
So, if i am reading your comments correctly, you have to spell correctly on Blog comment boards in order to have an opinion. Once again i wlecome any and all to challenge any of my statements of a philosophical level. All you can is spell check me. By any chance would Mark really be Mr Charmicael from LHS.
Anyway. my last employer was paying three hundred a month for my healthcare coverage. I do wish that the union were a bit more leniant on their demands, because i would of rather saved and paid cash for my medical attention. thats because i am 27 and in perfect health. but if i were elerly, i would very much prefer to pay a higher tax rate, than risk not getting the medical care i need
p.s mark i was with your wife last night. i got three words for you. all three holes. f u hall monitor
Que said: "long-standing policy, approved by the AMA House of Delegates, of reducing government interference with the work that goes on in a doctor's office or an operating room and is antithetical to what most doctors in America support."
The change in heart has been influenced by the for profit insurance companies "interference with the work that goes on in a doctor's office or an operating room and is antithetical to what most doctors in America support."
Under the plan, it is a panel of doctors, not profit driven bureaucrats, that decide what's best in terms of patient care.
Most doctors support the government run system because most of their time is spent on paperwork, dealing with different companies and their different rules, dealing with denied claims, a systematic practice,having to hire additional staff to deal with them and complete the mounds of paperwork, doctoring has now become a business - doctors must take less patients to deal with the layers of bureaucracy
"Jenny says: Que: I don't believe the AMA is an unbiased source of information on the topic. You do?"
No Jenny, YOU are the ONLY reliable source!
"indygirl says: Most doctors support the government run system"
Any link to that opinion?
But seriously Jenny. Let me ask you, just what sources WOULD be acceptable to you? If not the AMA? If not the Chairman of the British Medical Association? If not ANY source I have noted?
It would be easier if you gave that list of APPROVED sources ahead of time.
Que said: : "We have the best health care system in the world." Sources?
It is actually common knowledge that we don't. Just google "American healtcare compared" and you will find countless studies that rank the U.S last or near last overall compared to other industrialized nations that prorect their citizens with universal healthcare.
I wish libtards like indygirl would just pack-up and leave to Canada, Cuba, or hell even Detroit. Wah-Wah-Wah all they do is complain about living in the US, or what is wrong with the US, blah-blah-blah. Imagine a libtard free America, man I'm getting a "thrill runnin' up my leg."
Que said: "indygirl says: Most doctors support the government run system"
"Any link to that opinion?"
Won't let me post links to this fact, so just google:
Physicians for a National Health Program
"Our Mission: Single-Payer National Health Insurance"
and:
Doctors support universal health care: survey
"More than half of US doctors now favor switching to a national health care plan and fewer than a third oppose the ..."
Google each, they are at the top of the list...
Que: Last I checked, I wasn't shoving my ideas down your throat. You don't even read them, but come here - voluntarily - to harass people who don't agree with you. You don't have to like my ideas, and you don't have to support my work by continuing to come back - yet you do. Sucker.
Apparently, no one ever taught you how to weigh a sources credibility by the interests they represent. For example, a study by the oil companies telling me global warming is not man-made would be automatically suspect to bias. For this reason, independent, peer-reviewed, academic sources of information are the best we have. Not perfect - but the most credible. An organization like the AMA has a deep interest in how health care reform is structured - an independent research project may have bias, but no inherent interest in skewing the data.
Funny how all the people who swore they would leave if Obama were elected are now on the comment boards telling others to leave. We elected him for change - and we're getting what we want - too bad if you don't like it. Go get Glenn Beck, cry it out, and get over it.
Somalia has low taxes - perhaps you should consider leaving if Obama is too much of a socialist for your tastes.
You can post links by removing the http.
indygirl says: Just google "American healtcare compared"American healtcare compared"
Do YOU not have the facts you propose as true?
Bye Bye libtard said: "I wish libtards like indygirl would just pack-up and leave to Canada, Cuba, or hell even Detroit. Wah-Wah-Wah all they do is complain about living in the US, or what is wrong with the US, blah-blah-blah. Imagine a libtard free America, man I'm getting a "thrill runnin' up my leg."
I have never complained about living in the U.S., and I do try to raise awareness of the problems. Unlike you useless, do nothings that complain about people that do.
You and people like you are the reason this country is a mess and why the rest of the world thinks we are a bunch of morons. But of course, you don't care what the rest of the world thinks as long has you have the free will to power up your PC and "blah blah blah..." at the rest of us. If you can't add something relevant go Blah Blah Blah somewhere else...
Jenny, the AMA has ENDORSED ObamaCare!
"The American Medical Association on Thursday endorsed a liberal health overhaul bill that includes a public insurance option, a bold step for a traditionally conservative group with a checkered past on health reforms."
So much for your BIAS definition huh?
Hey Jenny is indygirl your pseudonym? Wow man that's like way cooool!
And THIS is from a source I am sure you approve of.
"The American Medical Association on Thursday endorsed a liberal health overhaul bill that includes a public insurance option, a bold step for a traditionally conservative group with a checkered past on health reforms."
www.huffingtonpost.com/2009/07/16/ama-endorses-house-health_n_235938.html
Jenny says: "Que: Last I checked, I wasn't shoving my ideas down your throat."
Is this not an open forum for the exchange of opinions and ideas? This IS a very important topic.
I just posted that this blog will not let me post links. So if you google:
Physicians for a National Health Program
and
Doctors support universal health care: survey
you will see the links.
And if you google "American healthcare compared" you will find lots of other links to support my assertion that the majority of doctors want a nationa health program.
I cannot help it if you choose to post non-factual information without finding out the facts for yourself, first. Trying to help you out here.
Incognito said: "Hey Jenny is indygirl your pseudonym? Wow man that's like way cooool!"
For the record, no, I am not jenny.
Pages
Got something to say?
Examiner.com is looking for writers, photographers, and videographers to join the fastest growing group of local insiders. If you are interested in growing your online rep apply to be an Examiner today!