Wednesday, February 10, 2010

Getting health reform done: the Taiwanese experience

My parents were both born in Taiwan, and about every four years (most recently, last November), I travel there to visit relatives. Since I was a child, Taiwan always struck me as in the same league as the U.S. with respect to advanced technology - in fact, they had the newest handheld video games (and later, the Nintendo Wii) months before these games arrived in stores in the States. But it wasn't until recently that I learned from a New York Times blog that Taiwan made the transition to unversal health care insurance in 1995, not long after the Clinton health care plan failed in the U.S. In a single year, Taiwan went from insuring only 55% of its population to 95%, and today the figure is close to 99%. (By comparison, U.S. Census data suggest that about 85% of the U.S. population has health insurance at any point in time, a figure that fluctuates as people lose their jobs and become poor enough to become eligible for state Medicaid coverage.)

How did Taiwan arrive at their health reform plan? After appointing several prominent domestic experts to a special task force that went nowhere due to differing views on how the new system should work, the government invited an American economic professor from the Harvard School of Public Health to break the impasse. As Dr. William Hsiao stated in an interview for the Times blog, "It turned out to be a big advantage that I'm not Taiwanese and had no aspirations of getting a job in Taiwan. At the end of the day, our recommendations and findings were perceived as more objective and free of self-interest."

The task force recommended that Taiwan adopt a single-payer model, analogous to the Canadian national health system. Highlights of the plan that was implemented include coverage for traditional Chinese medicine ("We tried to design a benefit package that would give people what they value," explained Hsiao), prevention and primary care, home health care, and a single, uniform electronic medical record system. With low co-payments and low administrative costs, the share of Taiwan's gross domestic product devoted to health care is about 6 percent, compared to 17.3 percent of GDP in the U.S. in 2009.

While it's hard to escape the irony of Taiwan inviting an expert from the U.S. - a country that has, after all, failed several times since the 1930s to enact comprehensive health reforms - to tell them what to do, the Taiwanese example is instructive as President Obama's bipartisan "health care summit" approaches. Perhaps our Congress should invite a foreign health policy expert without a stake in the outcome to make reform recommendations that are "objective and free of self-interest." Preferably from a country with more insurance coverage, better quality of care, lower infant mortality rates, and longer life expectancies than our own ... which, alas, leaves plenty of countries to choose from.


  1. There is good coverage of the Taiwan experience, along with 4 other countries which have done it at different periods (Britain,Germany, Japan, Switzerland) on TR Reid's Frontline special, Sick Around the World

  2. How big is Taiwan's population ? Any illegal immigrants ? How about geographical variation in income, culture and technology ?
    USA is a continent, not a country. Maybe that is the problem.