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
when will we have such a system?