Healthcare-Taiwan

Bare honest witness to the world as I have experienced with it.

‘Taiwan’s national health insurance (NHI) provides universal, mandatory coverage.’

Equity in both access and benefits

Effective and egalitarian cost control

Administrative simplicity to help the public understand the system

— — — Uwe Reinhardt, late former Taiwanese government advisor

How easy is it to go see a doctor in Taiwan? You open Google Map, type in the specialists clinics, choose one clinic on your way and you see a doctor right away. Appointment no need. When you get out of the clinic, just turn around, there’ll be a pharmacy that gives you the prescribed medication. The administrative and medical fee is about 10 USD.

I was straight from Switzerland to Taiwan in February 2021 after I quit my PhD, the first day out of my quarantine I went to a psychiatrist and get my pills against insomnia.

On receiving my medications, the diagnosis of bipolar and borderline personality disorder shocked me tremendously. The doctor explained that he had to give me a diagnosis such that I could be reimbursed. But let’s forget about the traumatizing diagnosis — -the price of the medication against insomnia was a great relief for me — I could finally afford the prescribed medications and health insurance.

Severe insomnia has followed me for 5 years since my graduate school in Germany. The German Government stated that obligatory internships were free, companies then exploited it as cheap labor force, I was one of them. Due to great financial stress panic attacks collapsed me one day. The accumulated stress due to typical foreign lives — -sexual harassment in student dorms, racial discrimination in daily life — — exploded all at once. My semester was suspended.

Since then sleeping pills and tranquilizers were always with me. Never was I asleep nor awake. Some part of my brain shut down. In the morning I opened my eyes, went to school, finished studies, found a job, went to work. A normal façade I put on.

In 5 years I moved from France, Germany, Belgium, Taiwan, Switzerland, Spain, back to Taiwan.

Life kept rolling, I took the pills and closed my eyes. But I couldn’t tell how much I travailed simply seeing a doctor in a foreign land. Coming back and forth from Taiwan to other lands has a great reason behind it — — the affordable and efficient healthcare.

So I wondered, how come the same treatment came with such different accessibility and prices? In Taiwan, I paid 30 USD per month for health insurance, roughly 5 USD for administrative fees per visit, and 15 USD for my tranquilizers and sleeping pills. And the other countries barely not.

Is healthcare a human right or personal responsibility? Answered the governments differently. The very essence of this philosophical question interpreted by different governments ended up as either either universal, commercial, public or private health insurances.

As for Taiwan, it is a parental government — healthcare is a human right, as stated in the constitution. But often forgot is then the responsibility that people take of their health.

‘Taiwan’s national health expenditures totaled 6.4 percent of GDP in 2017, of which NHI(National Health Insurance) accounted for 53.7 percent ‘— — on an individual level this meant that ‘6.4% of a Taiwanese’ income went to National Health Care in 2017.’

The medical prices that NHI paid to pharmaceutical enterprises uses reference pricing, in accordance with the median price in 10 leading developed countries: the U.S., the U.K., Australia, Belgium, Canada, Germany, France, Japan, Sweden, and Switzerland.

So the centralized NHI paid the same medical prices 100% as Belgium, Germany, France, and Switzerland — — — and charged patients at most 20%. Who then will fill the gap of 80% for NHI?

The health insurance? The taxes?

I paid 30 USD per month to NHI, went to psychiatrist once a month and paid them 15 USD in total for medication and administrative fee.

The medication I took per month cost 40 USD. So the rest 5 USD went to clinic.

In this case, how could doctors survive? Each time they only receive 5 USD. The profits are barely on the margin. So they increase the speed.

The hospitals increased the amount of patients, decreased the time of examination to the point where doctors are burnt out. The residential doctors in hospitals are the most vulnerable ones. Routine has it that twice a week they have to take a 28-hour straight shift for 4 years.

And in Taiwan, there are on average 2.1 doctors per 1000 residents in 2018, with Belgium, France, Germany, Switzerland having 3.3 doctors per 1000 residents — — the countries that we referenced our medication prices to.

I saw a good friend as a residential doctor himself suffer from insomnia, working stress and lack of rest because of the shifts.

Taiwan itself spends 6 years of college education on the top students to be medical doctors. They then become the exploited labour force that serve the country. In whatever regard this is not sustainable for anyone.

Should Taiwan be a democratic country, it is the people’s will that make the whole vicious circle — — we decide what we want. Human nature in economics is said to be greedy with limited resources.

So a democratic sovereignty with human nature — — catastrophic exploitation of medical doctors.

But have Taiwanese citizens ever granted directly the choice to change healthcare system, to top off the rate? Unheard of at least for me. I only read about governmental officials complaining about political pressure — — if ever they propose to elevate the rate, they’d lose the votes.

No, I will vote for topping off the rates. It’s necessary. The doctors in Taiwan deserve the respect and monetary reward. Such high efficiency and quality of medical services are unseen in any other place. I don’t want to lose it. It is our responsibility to make this system sustainable. Don’t wait until it’s too late.

Current Status

-accessibility(based on the waiting time for appointments & the —

-affordability — 45 USD per month vs. hourly minimum wage 5.92 USD

Now what?

How could the NHI system improve?

• increase the medication rate of the minor symptomes ,increase the rate of health insurance— -so that resources wouldn’t fall short and the money for minor medications can be used for introducing novel biomedications, and transfer the additive money into long-term care
• increase the medical doctors’ amounts each year for admission— — so that medical doctors, especially residential doctors in force wouldn’t have so much workload to take care of the residential patients

All the above proposals would only work if NHI system is referéndum-able, that people could decide what is best for them. So the last item on wish-list is, let people decide.