An American’s insight into the NHS

By Adam Chimienti





If you ask the average US citizen about Taiwan, they might not be able to tell you much about the nation. Many may remember Taiwan for its advanced industrialization, recalling the era when the label “Made in Taiwan” was ubiquitous throughout the US.

However, those with greater international awareness could tell you that Taiwan has an excellent and innovative healthcare system. Some might even be able to explain how Taiwan’s National Health Insurance was, in part, based on the Medicare system for people 65 and over in the US.

After living, teaching and studying in Taiwan over the past four years, I can honestly say that the National Health Insurance system here has saved my life and made me a much happier person.

In 2009, I was increasingly having gastrointestinal problems and prior to living here, I was never really able to do anything about them. I did not know what was wrong, or believed that the medical system could help me — that is until it was almost too late.

I was rushed in for emergency treatment in March 2009, had two major surgeries, and was forced to stay in the hospital for more than two weeks. I received excellent round-the-clock care from the doctors and nurses and received a complex array of medication and support in a private room.

I left the hospital in pain, knowing I had a long road to full recovery, but I was very surprised and incredibly grateful when I received the medical bills for the whole ordeal.

The total out-of-pocket costs were a mere fraction of what they would have been in my native New York.

Indeed, if I was living in New York when I needed emergency medical attention, like many other Americans, I might not have even gone to the doctor or hospital for fear of the financial burden of medical treatment that we are so accustomed to and anxious about.

If I did go in to receive the treatment and was lucky enough to find the same level of patient and quality care, then I surely would be paying off those debts for the rest of my life.

Therefore, I can say with confidence that moving to Taiwan is one of the best and most timely decisions I have ever made. Moreover, my wife and I decided to have a child here, confident we would receive excellent care and the freedom from the financial anxiety typically associated with childbirth in the US.

There has been much discussion over the years about the solvency of the National Health Insurance Program and experts are genuinely worried. Most alarming is the strain of underfunding on the medical workers who are unduly bearing the burden of a healthcare system in a modern, highly populated country with increasing rates of serious illnesses.

However, we should remember that this is one of the best systems in the world.

There should be genuine leadership when it comes to guaranteeing the continued excellence that has defined the system and aim to modify it in a way that meets the needs of the doctors and other workers operating within the system.

To borrow the popular US term for the banking and financial companies that needed a government bailout during the financial crisis, the system should be regarded as “too big to fail,” and committees of doctors, bureaucrats and politicians should find ways to raise the revenue, regardless of how unpopular the necessary approaches may be politically.

With a little more innovation and marketing, this program should continue to serve as a model for the world to study and embrace.

First, let us remember that the National Health Insurance Program is rather efficacious in many of its most important goals. It provides excellent care and a freedom of choice for all those enrolled on how they heal themselves and which doctors to seek help from.

The system has among the lowest administration costs of any healthcare system in the world. We should remind ourselves that Taiwan’s system is more efficient than that of Austria, Germany, South Korea and Japan, according to a comparison by the WHO.

Second, Taiwan’s system cannot be privatized or scaled back without a major detriment to Taiwanese everywhere, rendering such changes unworkable.

There is no alternative (such as privatization or rolling back the vital and comprehensive services) that is socially acceptable.

The mostly private US system has myriad problems and these inefficiencies have resulted in more than 45,000 deaths in each of the past several years, according to a Harvard study by Steffie Woolhandler.

The incredibly expensive US system has more than 16 percent of the GDP going towards healthcare expenditure, compared to Taiwan’s 6.7 percent, but this astronomical amount still leaves about 50 million people without insurance.

Third, if Taiwan really wants to avert bankruptcy in its healthcare system, why not advance the cause of healthy living to cut down on illnesses?

Getting more aggressive on the enforcement of vehicle emissions and the curbing of industrial pollution, raising taxes on cigarettes (a pack costs five times more in New York than in Taipei) and other unhealthy lifestyle choices, would save the healthcare system much money in the long run.

Additionally, increased advocacy of vegetarian diets and meat-free days can all lead to a healthier nation.

These methods have all been attempted recently but maybe they should go further, while additional revenue through excise or luxury taxes can be earmarked for the National Health Insurance Program, benefiting everyone.

There is plenty of research to support the idea that raising the price of cigarettes, alcohol and other unhealthy lifestyle choices serves to decrease the amount of their use by people, leading to improved health, while also allowing the price of these items to be genuinely measured in terms of related social costs.

Yes, the costs of Taiwan’s system are rising steadily and funding is a serious issue, but if the system is meant to serve everyone’s health needs, then it has proven remarkably effective in doing so.

The program has also provided greater freedom of choice to Taiwanese (and even foreign workers).

Why not celebrate the system for what it has done right and continue to innovate and find new ways to reduce costs and fund aspects of the system that desperately need it, and commit to saving people’s lives?

This healthcare system, created in 1995, is internationally renowned and highly popular at home. Hold the National Health Insurance Program and a healthy country up for the rest of the world to see and show them Taiwanese innovation where it matters most: creating a fair and healthy society.

Adam Chimienti is a doctoral candidate at National Sun Yat-sen University’s Institute of China Asia Pacific Studies.