Taiwan, an island state of 23 million inhabitants, has been regarded as a “health utopia” given its accessible and affordable universal national health insurance program established in 1995.
1
The National Health Insurance's (NHI) continued high performance with relatively stable health spending, at approximately 6% of the gross domestic product, has greatly enhanced equitable access to medical care throughout the country.
2
However, the rapid escalation of health care costs and the financial difficulties including debt-dependent status and limited revenue base that the NHI has experienced in recent years has raised concerns about the sustainability of the Taiwanese health utopia. Taiwan faces continuing challenges to sustaining its universal health care system, including a rapidly aging population, public ignorance of disease prevention, inefficient economic policy making, and a shift in patterns of specialty selection toward high-profit and “clean” specialties (eg, dermatology).
In this letter, we suggest potential solutions for sustaining the Taiwan NHI.
• Evidence-based policy development: This process is key to modifying and improving the NHI. Our government should encourage more policy-oriented research and facilitate translational public health practice. Establishing a national public health practice-based research network is critical to describe the epidemiological profiles of major diseases and to streamline effective evidence-based policy design and intervention. Currently, there is scarce timely, policy-relevant, and health care economic research from the Taiwan NHI database compared to biomedical and clinical research. Such an unbalanced trend would seriously weaken the quality of policy making. Without systematic analysis of medical-seeking behavior, quality of care, aging population dynamics, and economic modeling, it is nearly impossible to determine a reasonable premium, as the necessary data specific to Taiwan are not available.
• Development of a high-quality national health information database. Utilizing standard coding protocol, this database would store quality assurance information pertaining to clinical performance, patient outcomes, adverse events, and teaching qualities from each hospital participating in the NHI.
1
As a whole, the database would provide the basis to analyze behavior, quality, and ethical issues central to improving the current health care system. However, to date, development of a high-quality database has been inhibited by low financial incentives for physicians and short doctor visits, which average 2–5 minutes per patient per visit.
3
The Taiwanese government must end this vicious cycle.
• Multidisciplinary training and practice: The Taiwanese government should facilitate more diverse training in areas including politics, public health, social affairs, and economics while also providing avenues to cultivate more interdisciplinary clinicians. This would effectively enhance public health communication at the population and political levels among clinicians, the general population, and the government.
Taiwan's experience has indicated that the design of the health care payment system could influence specialty selection, which further harms the “health” of the current health care system. Furthermore, without suitable relevant evidence, the framework of a sustainable insurance system couldn't be efficiently modified. Because the debate on reforming the current health care system continues to revive, Taiwan's lesson is practical and informative and could be specifically applied to other developed countries with regard to the importance of building a comprehensive database to formulate a cost-effective/affordable health policy.
