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The Achievement of National Health Insurance

The Achievement of National Health Insurance

To celebrate the 10th anniversary of National Health Insurance, Bureau of National Health Insurance held an international symposium on March 18 and 19, 2005.

In the symposium, Dr. William Hsiao (蕭慶倫) the initial convener of National Health Insurance program and is also a professor at Harvard University said "For the past ten years, no other countries in the world can match the achievements of Taiwan's National Health Insurance." He said, "National Health Insurance's achievements are the high coverage rate, comprehensive benefits and the high accessibility."

More than thirty guests from all over the world gathered in this symposium to discuss comprehensive issues of health insurance. Many of them are distinguished government officials or planners who is responsible for their countries' health insurance program. Those people are Mr. Petr Slama, the vice- minister of the Czech Republic; Birol Aydemir, the deputy secretary of Turkey's State Planning Organization (DPT); Dr. Francisco T. Duque III, the Secretary of Department of Health and Dr. Orie Andari Sutadji from Indonesia National Health Insurance Company (PT ASKES).

Since the beginning of 1950s, Taiwan has implemented several social insurance programs. These programs include labor insurance, government employee insurance, farmer insurance and low- income household insurance covering only about 59% of the population. In other words, about 41% of the population are not included by those insurances and the great part of these people are below age 14 or above 65, living in remote mountainous areas or offshore islets. However, these people need assistance the most and are vulnerable to poverty and illness. National Health Insurance Program was launched on March 1 1995. It provides health care for all Taiwan citizens. By the end of 2005, 99 percent of the total population were covered by the NHI program.

One may wonder, what have Bureau of National Health Insurance done to have these achievements? Please see the followings:

1.Taking good care of the disadvantaged groups

To help disadvantaged groups, government offers several relief measures, such as premium in installments, interest- free loans, and referral to charity organization for premium grants and assistance for the jobless. In order to offer the people who living in the remote mountainous areas or offshore island access to good medical care , the Bureau of National Health Insurance implemented the integrated delivery system (IDS) plan. This plan encourages doctors to work in these areas to solve the medical problems so people could have prompt medical treatments there. So far, the IDS plan has been launched in all 48 aboriginal townships.

Especially for those with serious illness the national health insurance provide them great benefits. By the end of 2004, there are more than 550 thousands people (about 2.5% of total insured) who hold catastrophic illness card using some 24% of total health expenditure. National Health Insurance plays a stabilizing role of the society.

2. Devoted to increase the quality of medical care

The first step of this task is to establish consensus between the public and medical sector. In 2004, DOH delegated scholars to study the feasibility of Quality Report Card. The Quality Report Card can reflect people's opinion of medical treatment and doctors' opinion on publicizing the medical information which is important to build a consensus on the quality of medical treatment.

The survey shows that people care most about the percentage of erroneous prescription, the attitude and clarity of doctors' explanation. For doctors, they don't think publicizing the medical treatment quality report would cause any pressure, (70%) but which do help a lot to improve the medical treatment quality (68.29%)

With the care of National Health Insurance , poor people can get medical treatment and thus the survival rate of disease increase and people's longevity expands. According to the data of 2000, the median age of people dying from cancer increase from 65 to 68; the average age of male in 2003 was 73.3 and of female is 78.82 an increase by 1.56 and 1.06 compared to1994. In terms of the quality of National Health Insurance, The survival rate of colon cancer(male-42﹪,femeal-46﹪), lung cancer(male-11﹪, female-11 ﹪) and female breast cancer(68﹪)within 5 years which are also close to developed countries.(chart 1)

3. Referral System makes serious- disease patient safer

In order to provide patients appropriate medical treatment, the Bureau of National Health Insurance is promoting a referral system (family doctor) in which people first go to the clinics when they get sick. They will be referred to the hospitals only if they need further examination, surgery or hospitalization. In so doing, the workload of hospitals can be eased and the medical resources of hospitals will be better utilized on patients with serious diseases. The family doctor in the community will be responsible for whole family's health. Ordinarily, family doctors are people's health care advisers who also render basic treatment. If the patients need to be sent to the hospitals for further examination or treatment, family doctors will advise them on the proper hospital or medical institutions. Thus people can save on time and money looking for the right doctors.

4.Bureau of National Health Insurance dedicated to make information available to the general public

Since the implementation of National Health Insurance from March 1, 1995, the Bureau of National Health Insurance polls in every few month. The survey shows that the percentage of satisfaction had risen from 39% in May 1995 to 76% in December 2004. The percentage of dissatisfaction descended from 47% in May 1995 to mere 13.3% in December 2004. The high satisfaction and low dissatisfaction signify the achievement of the National Health Insurance (Chart 2)

5.National health insurance program is highly regarded among the international community

Taiwan's health insurance program is ranked No.2 by the Economist Intelligence unit's "World Health Ranking" of 2000, behind only Sweden. Moreover, in the column of New York Times, the renowned economist Paul Krugman urged the U.S to look to Taiwan's National Health Insurance. Paul Krugman is an economic professor at Princeton University. In 1994 when he taught at Massachusetts Institute of Technology, (MIT) he predicted the Asian Financial Crisis. At present, he is the editorial writer in the New York Times. Every week he publishes article commenting U.S. economy policy. The title of his article is "Pride, Prejudice, Insurance." In the article, he praises Taiwan's National Health Insurance for enhancing the coverage from 59% of the population to 99%. But the total increase of medical expenses still accounts for a small portion of the household income. For the U.S., from 2000 to 2004, the population has increased by 10 million under age 65, however, the health insurance acquires by employment had decreased by 4.9 million. The system of health insurance is fading out. Krugman hoped Americans can give up the ideas of "no need to learn from other countries" and "private insurance is more effective than public insurance." He also emphasized that Taiwan's experience is an important reference for the U.S. to tackle with the U.S. health insurance problems.

The achievement of National Health Insurance is not only the provision of better medical care but also the expenses it holds. The percentage of the medical insurance expenses in GDP has increased from 5.27% in 1995 to 6.26 in 2003. Even so, the percentage is lower than the average of the OECD members with 8.76% , much lower than the U.S.'s 15 %, the Great Britain's 7.7%, Germany's 11.1% and Canada's 9.9%(chart 3). Furthermore, according to the data of OECD, the average medical spending of Americans is $ 5635, Canada $ 3001, Germany $ 2996 and the Great Britain $2231 in 2002. The average medical spending of Taiwanese is $ 819. The figures above show that even though National Health Insurance is covering every citizen, the spending is still in a rational limit.

Future plans:

Promoting International cooperation

Because Taiwan's national insurance is highly admired in international community, many foreign guests come to the Bureau of National Health Insurance for consultation. In these years, health institutions, media, congressmen and officials from Korea, Japan, the U.S., Indonesia and New Zealand have come to visit Taiwan's Bureau of National Health Insurance. For the countries planning health insurance plans such as Philippine, Indonesia and Malaysia organize groups to visit Bureau of National Insurance for more detailed information.

In 2005, there were 398 delegates from 39 countries that visited Bureau of National Insurance, among them, 5 are ministers of Health or, vice- ministers, 38 congressmen and 80 professionals from health insurance institutions. The Bureau plays a role in health diplomacy, it is generally observed.

"We have laid a solid foundation on health insurance. But in this fast-changing world, we have to keep up with the pace of reformation. In the future, we will mend the flawed parts for providing our nationals the best medical care says President Chen at the opening of the International Symposium of the 10th year of National Health Insurance.