This week NPR has a piece on Taiwan's wonderful health care system, Taiwan Takes Fast Track to Universal Health Care:
At the end of the 20th century, Taiwan became a rich country, almost overnight. But it still had a poor country's health care — about half the population had no coverage at all. So Taiwan set out to design a national health care system from scratch. What makes Taiwan unique is the way the country figured out how to cover everyone.
As NPR notes, Taiwan covers almost everyone, and manages to keep costs down. I don't know any foreigner who lives here who would trade the Taiwan system for the US one. Come below the fold to read more:
Taiwan formally gave up martial law in 1987 though the security laws remained in place and political prisoners in prison for several years afterwards. During the martial law era the democratic opposition advocated for a universal health care system, and in the 1990s, when the democratic era came in full flower, the administration of then-President Lee Teng-hui, who co-opted many of the democratic opposition's ideas, borrowed that one too.
As NPR notes....
They wanted a system that gave everybody equal access to health care — free choice of doctors, with no waiting time — and a system that encouraged a lot of competition among medical providers.
To finance the scheme they chose a national insurance system: a single, government-run fund that forces everybody to join in and pay.
The result is a system that works a lot like Canada's, or like the U.S. Medicare system, but with more benefits.
"It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care, just about everything under the sun," Cheng says.
To satisfy the patients in Taiwan, there's no gatekeeper who controls access to specialists and no waiting lines.
If you woke up in Taiwan with shoulder pain, for example, Chang says that you would be able to see an orthopedic specialist the same morning, no recommendation from a general practitioner required.
That is exactly correct. Two weeks ago I screwed up my knee playing basketball and went right down to the local hospital to see an orthopedist for it. With drugs, the total cost of my visit came to a whopping US$12. A couple of weeks before that my daughter banged her head on a piece of metal and we took her to the emergency room with a concussion. X-rays were negative, but the doc kept her for six hours for observation. He said that if an MRI were necessary, we might have to pay US$60. $60! In the US an MRI would cost hundreds of dollars. The total cost to me for all this care was roughly US$20.
The article further describes:
Everybody here has to have a smart card to go to the doctor. The doctor puts it in a reader and the patient's history and medications all show up on the screen. The bill goes directly to the government insurance office and is paid automatically.
So Taiwan has the lowest administrative costs in world: less than 2 percent.
They also use that smart card to track patterns of use.
"If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out. The person then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well," Cheng says.
That may be too much like Big Brother for some people in the United States, but surveys show the Taiwanese are highly satisfied with their health care.
The digital card is fast, convenient, and safe. Here's a pic of mine:
I can use this card at any hospital or clinic in the system anywhere in Taiwan, whether I have ever been there before, irrespective of what problem I have. In hospitals I can choose what doctor I see and when, and I don't have to get a GP to set up the appointment.
I am a foreigner with the equivalent of a Green Card through my wife, and am covered through my job. Foreigners who have work visas and pay taxes are also covered.
The Taiwan health care system also covers Chinese medicine, and there are medical schools to train practitioners. Chinese medicine isn't much use if you have something pressing, like appendicitis, but if you have chronic pain, people often turn to it. I'm personally ambivalent about the ethics of spending government money on health practices that are unproven, but it is salient that many people obtain placebo benefits, and money is actually saved when chronic sufferers choose cheaper Chinese medicals that offer little relief over expensive imported western meds that offer little relief.
As NPR notes the system borrows money, because it is too cheap. Everyone realizes that if prices were raised a little, it would be solvent, but politicians won't make the hard choice here. It also suffers from other problems, such as overprescription of medicines, and corruption, endemic in all government programs here. For example, administration of the system is national and each area has a fixed number of hospital beds based on usage and population, in theory. In practice politically connected organizations can use their clout to exceed these quotas, and "extra" hospitals to farm subsidies exist. But relative to the ease of use and costs of the system, Taiwan's health care system is excellent and its problems are fixable.
The benefits of this system are obvious: fewer people are bankrupted by health care costs. Unlike the US, which is dead last among major industrial nations in rates of small business, Taiwan has a robust small- and medium-entreprise sector that is about 95% of all businesses and contains 80% of all employed. The US health care system is killing our vital entrepreneurial sector. It is also killing Americans in droves.
A major reason I enjoy living here and won't go back to the US is that the health care system in Taiwan is so much better than the brutal, uncivilized system operated by the US and touted by corporate shills as "the best health care system in the world." People who make claims like that are sick in a way that, regrettably, no health care system can fix.
Vorkosigan
The View from Taiwan