The following is a news article on Taiwan's Medical Insurance
Scheme which is deemed as the most successful one in Asia, second
to Sweden in the whole world.
Yes, they do not need a multi-million annual salaried Heath
Minister to come up with this.
They do not need Health Minister to suggest vividly that
citizens looking for cheap medical care should go across the
causeway.
Translated by Goh Meng Seng.
Taiwan World Class Medical Insurance
The article written by Dong Qing Feng published in the most
recent issue of Asiaweek has pointed out that Taiwan's Medical
insurance system is regarded as one of the best model for the
world. From Medical demand, Medical supply etc. it has been praised
and ranked second only to Sweden. Few of the main reasons for such
high ranking include the hardworking doctors, low wages for medical
staffs, few medical disputes and compensations and most
importantly, most of the medical institutions are run and
controlled by the government.
The report points out that last year, Nobel Prize winner, Economic
Professor of US Princeton University and column writer for New York
Times, Professor Paul Krugman, has praised Taiwan's Medical
Insurance system in New York Times and urged the Americans to
emulate such system.
Krugman believes that the Taiwan Medical Insurance system can
provide a good example for all Americans to be insured within their
economic means. He reiterates that within a short period of six
years, the growth in the number of Taiwanese being medically
insured has raised from less than 60% to 97%. Besides, the cost for
all Taiwanese to be insured is very low and it takes population and
income growth into account. Even if the cost of medical care
increase, the increase will be insignificant.
The Taiwan medical insurance system was implemented in 1st March
1995. It was one of the greatest achievement of the KMT when Lian
Zhan was the Prime Minister then. It becomes famous in the world
for providing low medical insurance premium, wide medical coverage
and convenience resulting in high subscription rate by Taiwanese.
Taiwan Medical Insurance scheme consolidated workers, laborers and
farmers medical insurance payment and created a single entity
medical insurance for all. It implements a single payment channel
and a gross payment system.
This National Medical Insurance scheme embrace the spirit of social
insurance, which is risk sharing and under the fundamental guiding
principle of mutual help, the young will earn money to take care of
the medical risks of the aged. In doing so, it achieves mutual aid
across different generations and races. It also creates a huge
health database that could be used by healthcare research. On the
other hand, the administration cost has been kept under 2% and that
is why it has been praised internationally.
In 2000, EIU has ranked Taiwan's Medical Insurance scheme as number
two under medical demand and supply, second only to Sweden in the
whole world. The ABC has praised Taiwan's Medical Insurance scheme
in one of its program broadcast in 2003, pointing out the fact that
with a monthly medical insurance premium of US$20 and an average
cost of US$4 to US$10 for every medical visit, you could make
appointment to any hospital with any preferred doctors of your
choice in Taiwan. There are at least 50 countries around the world
that have paid visits to Taiwan to study its Medical Insurance
scheme in recent years.
Taiwan Medical Insurance Scheme has been well known to be value for
money. Base on their income, Taiwanese will pay a token amount of
insurance premium every month and they will be able to enjoy all
kinds of medical services. Regardless of rich or poor, big
hospitals or small clinics, all will receive the same level of
medical services. All will receive equal treatment. Even if the
rich wish to pay more for additional privileged services, it will
be prohibited. Besides, it is very convenient to get medical
services there, with big number of hospitals and clinics
availability all throughout Taiwan. You can pick and choose your
choice of hospital or clinic without any need of doctor's
recommendation.
The Medical Insurance is not solely born by the people. Private
companies and the government will have to share the cost of the
premium as well. Those companies that bought workers' insurance for
their employees will have to pay for their medical insurance as
well. This is due to the fact that such insurance premium will
include workers' insurance and medical insurance. The present law
dictates that employers will have to bear 60% of their workers'
medical insurance, employees and their family members will bear 30%
while the government will bear 10%.
Taiwan Medical Insurance Scheme's premiums are based on income
classification. The premiums are charged according to 10 different
classes of income. For example, those who earn less than NT$17280
(about US$500) will pay only NT$600 as monthly premium. Those with
monthly income more than NT$131700, they will pay a monthly premium
of NT$5400.
Foreign workers are included in the Medical Insurance Scheme.
Due to the fact that the National Medical Insurance Scheme is
compulsory for all, everyone will have to be admitted into the
Medical Insurance Scheme. This will include foreign students,
migrants and even foreign workers. Its core value is “Big illness
for Hospitals, small illness for small clinics” . Everyone who seek
medical care, apart from paying the basic administration fee,
patients will have to bear part of the medical cost.
Ex-DPP Legislative Yuan member Sheng Fu Xiong has a heart
operation, warded for 4 days. The operation implanted a blood
vessel widener for him. He paid about NT$20000 (about US$600), the
medical insurance has helped him paid a few hundred dollars. Such
operation will cost more than a million of New Taiwan dollars
without medical insurance.
Taiwan Medical Insurance is very Cheap!
As a medical doctor, Sheng Fu Xiong is one of the few in
Legislative Yuan who are regarded as those who have put in lots of
effort in researching on the Medical Insurance Scheme back then. He
pointed out that the insurance premium that each Taiwanese has to
pay is about one sixth to one eight of US medical insurance
premiums and this is very cheap!
Taiwan's Medical Insurance Scheme is the creation of Harvard
professor Xiao Qing Lun and this creation is based on the study of
Canada's united insurance system. However, Canada's medical
insurance scheme is basically a failure, why does Taiwan's scheme a
success then? Sheng Fu Xiong pointed out that firstly, Taiwan
doctors are just too hardworking. Many doctors has to see 120
patients a day (while in US, the average is only 30), this is very
rare and unique in the world. Secondly, Taiwan's medical staff,
apart from doctors, like nurses, physiotherapists, nutrionists,
psychiatrists, pharmacists etc., are fewer in comparison and their
wages are lower. Take nurses for example, their pay is only 20% of
US nurses. Thirdly, there are few medical disputes in Taiwan, there
are less medical related lawsuits. Even if there are, even if the
doctor lost the case, the compensation amount is not high.
Compensation for death caused by erroneous diagnosis is at most
NT$1m to NT$2m, some are even below NT$1m. Forth, all American
medical institutions are listed company, the pressure of
profitability is higher. Taiwan's medical institutions are
prohibited from listing in the stock exchange, most of them are run
and subsidized by the government.
In comparison, Canada's medical insurance system does not have all
these advantages. Sheng Fu Xiong pointed out that most important of
all, Canada does not have efficiency. If a patient needs an
operation that is deemed as non-urgent, like an operation on hip
joint, they will need to wait for at least 6 months. In Taiwan, the
same operation will only take 1 week to be completed.
Sheng Fu Xiong revealed that a few years ago, Hong Kong government
was considering of implementing a system similar to Taiwan's
Medical Insurance scheme. Xiao Qinglun has travelled to Hong Kong
to explain the scheme to the Hong Kong officials. He was engaged by
the Hong Kong government to do a feasibility study there but in the
end, he recommended against implementing such a scheme in Hong
Kong. The Hong Kong government has accepted his recommendation. “I
feel that it is right not to implement it” This is because this
system could only be successful in Taiwan, it will fail in other
parts of the world. “This is the fruit of Taiwan's special
circumstances”.
Hong Kong's system is the middle path between Taiwan and US.
Sheng Fu Xiong said that one of the main reason that it is not
suitable for Hong Kong to emulate Taiwan's Medical Insurance scheme
is that Hong Kong doctors are not as hardworking as Taiwan's, there
are more medical staffs than Taiwan, salaries are higher than
Taiwan and there are more medical disputes than Taiwan.” He said
that Hong Kong's system is a middle path between Taiwan and US. It
has all the bad points that US has but the problems are not as
serious as US. Hong Kong does not have the good points that Taiwan
has, like hardworking doctors, low compensation for medical
dispute, medical institutions are not listed on stock
exchange...etc.
Sheng Fu Xiong criticize Krugman as an amateur. Although Krugman is
a Liberal but he has socialist influence in his heart. Thus, he
does not discount government intervention totally. However,
Taiwan's Medical Insurance scheme is a single provider and it under
heavy influenced by the governmental system. Besides, it is not a
multi-insurance scheme but a unison insurance scheme and this is
the role played by the government. He only sees the beauty of
Taiwan's Medical Insurance Scheme but not the potential problems.
It is due to the fact that the Taiwan Medical Insurance scheme is
based on a collapsible structure that it needs to be
reformed.
Taiwan government has paid nearly NT$400Billion per year but
medical experts criticize that the medical wastage every year
amount to Nt$10billion resulting in the Medical Insurance scheme
recording deficits every year. Sheng Fu Xiong pointed out that the
potential worries of the Medical Insurance scheme is “the growth of
our premium collections could not catch up with the growth of the
medical expenses.” Thus every time when the accounts are balanced,
3 years later it will become a deficit again. In another words,
expenses are always bigger than premium collections and this is due
to the lack of restrains and the spirit of free market principles.
Taiwanese like to visit hospital, even for a small flu, they would
visit the big hospital. Some mother would bring their children to
GP in the morning. If there is no significant improvement, they
will bring them to otolaryngology in the afternoon. This is almost
impossible in US.
One of the main reason for such high medical expenses for the
Medical Insurance Scheme is that Taiwanese are used to taking
medicine. For the whole of last year, the expenses on medicine by
the Medical Insurance scheme has reached NT$125Billion, an increase
of 6.9% from the previous year. Among these expenses, medicine for
hypertension, glucagon and statin has amounted to NT$32.3Billion.
The top medicine “MaiYou” alone, which is used mainly for treatment
of hypertension and strengthening the heart functionality, has
consistently top the list of medicine for 8 years, cost almost
NT$4.5Billion per year.
Due to popular demand, I have decided to spend some time in
translating the Chinese article on Taiwan's World Class Medical
Insurance here.
Goh Meng Seng
http://singaporealternatives.blogspot.com/2009/04
http://singaporealternatives.blogspot.com/2009/04