The World Health Organization (WHO) constitution states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” In Taiwan, this principle is realized through the National Health Insurance (NHI) program, a global benchmark in universal medical care. Taiwan’s expertise in developing this system warrants sharing with the international community through the World Health Assembly (WHA)—the decision-making body of the WHO.
Launched in 1995, the NHI is a compulsory single-payer social insurance plan covering virtually every citizen and foreign resident. It offers convenient access to inpatient and outpatient services, dental care, prescription medications and traditional Chinese treatments at affordable prices. Users are free to choose doctors and hospitals from over 25,000 contracted facilities, enjoy short wait times and seek specialty care without referral.
Social justice is the pillar on which the NHI is built. Premiums come from the government, employers and employees, with the fee set as a proportion of salary, currently 4.69 percent. Workers pay 30 percent, employers 60 percent and the government the remaining 10 percent. There is also a 1.91 percent levy on supplementary earnings like bonuses and stock dividends to ensure contributions reflect a user’s full income. For households below the poverty line, the premium is fully subsidized.
The NHI has secured consistent improvements in public health while keeping costs in check. Since its establishment, average life expectancy has risen from 74.5 to 80.2 years, while health disparities between socioeconomic groups as well as urban and rural areas have narrowed. In addition, health care expenditure totaled 5.9 percent of gross domestic product in 2016, significantly lower than the average of 9 percent for that year among Organization for Economic Cooperation and Development countries, according to the Ministry of Health and Welfare (MOHW).
This cost-effectiveness results from minimized administrative spending. Related expenses accounted for 0.9 percent of total outlays in 2017, the lowest ratio in the world.
Administrative efficiency, as well as oversight of service utilization and quality, is achieved through a powerful centralized information technology system. Every user carries a unique NHI card that tracks personal data including diagnoses, drug allergies and prescriptions, major illnesses and palliative care directives. This strengthens service delivery, promotes medical R&D and provides a potent tool to halt the spread of epidemics. In case of emergency situations such as the 2003 outbreak of severe acute respiratory syndrome, or SARS, authorities can request real-time data updates, enabling rapid identification of potential patients.
The NHI has earned widespread acclaim at home and abroad. In an MOHW survey conducted last year, 85.8 percent of respondents expressed satisfaction with the program. And every year the ministry welcomes scores of foreign delegations eager to learn about the Taiwan model, including more than 50 groups in 2017.
In line with the universal right to health on which the program was founded, the government has enacted several amendments in recent years to expand coverage. The second-generation NHI, unveiled in 2013 to ensure the system’s financial stability, enrolled Taiwan’s 60,000 prison inmates. And since December 2017, babies born to foreign residents—previously eligible to join after six months—have been included at birth.
As evinced by the NHI, Taiwan has fully embraced the WHO’s founding principle and stands as definitive proof that health for all is an achievable goal. Taiwan would relish the opportunity to attend the 71st WHA May 21-26 in Geneva so it can share its extensive expertise in the realization of this objective with the international community.