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Taiwan’s National Health Insurance: What Worked and What Didn’t?

Taiwan’s National Health Insurance: What Worked and What Didn’t?.

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Taiwan’s National Health Insurance: What Worked and What Didn’t?

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  1. Taiwan’s National Health Insurance:What Worked and What Didn’t? Prepared for Conference on Public Health and Preventive Medicine 2010, The World Federation of Chinese Public Health Professionals and The Hong Kong Tuberculosis, Chest and Heart Diseases Association, November 6-7, 2010, at the Hospital Authority Building, Kowloon T.L. Chiang College of Public Health, National Taiwan University E-mail: tlchiang@ntu.edu.tw

  2. HEALTH TRANSITION IN TAIWAN Communicable Disease Control Healthcare for All Health for All Crude Birth Rate Life Expectancy Crude Death Rate Traditional Public Health New Public Health

  3. TAIWAN - 2008 • Socioeconomic background • population23 million • density637 persons per square km • GNPUS$17,576 per capita • education35% received higher education • aging 10.4% population aged 65+ • Population health • lifeexpectancyM/F: 76/82 yrs • majorkillers cancer, heart disease, stroke, diabetes, accident

  4. CONTENTS • Taiwan’s NHI: An overview • Objectives • Main features • What worked • Access to health care • Catastrophic health spending • What did not • Inefficient use of health care resources • Widening health inequalities

  5. Taiwan’s NHI

  6. Taiwan’s NHI THE BIRTH OF TAIWAN’s NHI Full Congress Election Democratic Progressive Party US De-Recognition NHI Law Withdraw from UN President Election

  7. OBJECTIVES OF TAIWAN’S NHI • Equity in access to health care To provide equal access to adequate health care for all citizens in order to improve people’s health • Macro-economic efficiency To control health care costs at a reasonable (or socially affordable) level • Micro-economic efficiency To promote the efficient use of health care resources -better health outcomes and cost effectiveness

  8. MAJOR NHI FEATURES • Universal coverage • Comprehensive benefits • Western medicine, Chinese medicine • ambulatory care, EMS, inpatient care, home care • coinsurance rate of 10-20% plus … • Public single-payer • National global budget • Health spending as % of GDP - 6.4% in 2008

  9. PUBLIC STATISFACTION W/ NHITaiwan, Since 1995

  10. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

  11. What worked

  12. WHAT WORKED • Equal access to health care • Ambulatory care • Inpatient care • Prevention of poverty trap

  13. ANY USE of PHYSICIAN SERVICESBefore and After the NHI Source: Cheng HS, Chiang TL. The effect of universal health insurance on health care utilization in Taiwan – results from a natural experiment. JAMA 1997; 278:89-93.

  14. ANY USE of HOSPITAL SERVICESBefore and After the NHI Source: Cheng HS, Chiang TL. The effect of universal health insurance on health care utilization in Taiwan – results from a natural experiment. JAMA 1997; 278:89-93.

  15. WHAT WORKED • Equal access to health care • Prevention of poverty trap • Catastrophic health spending

  16. CATASTROPHIC HEALTH SPENDING*W/out and With NHI, 2004 * Out-of-pocket health spending exceeds 40% of household non-food consumption

  17. CATASTROPHIC HEALTH SPENDINGAsia Comparison, circa 2000 Source: Van Doorslaer E and EQUITAP team. Catastrophic payment for health care in Asia. Health Economics, 2007;16:1159-84.

  18. What didn’t work

  19. WHAT DIDN’T WORK • Meeting social expectations • Aging society and big tickets • Sustainable financing • Tackling health inequalities

  20. POPULATION AGINGTaiwan, 1950-2050

  21. SUPPLY OF ACUTE HOSPITAL BEDSTaiwan 1994 vs 2003

  22. FINANCIAL STATUS OF TAIWAN’S NHIAccrual Basis, Since 1996 Deficits

  23. WHAT DIDN’T WORK • Meeting social expectations • Tackling health inequality • Limitations of medical care • Widening social gap in health • Unequal treatment and mortality

  24. PHYSICIAN SUPPLY AND HEALTH GAINSTaiwan, 1950-2000

  25. LIFE EXPECTANCY AT VARIOUS AGESTaiwan, 1985-2005 March 1, 1995

  26. LIFE EXPECTANCY BY CITY/COUNTYTaiwan, 2005-2007 Years

  27. ALL CAUSES MORTALITYBefore and After NHI

  28. UNDER FIVE CHILD MORTALITY1990 vs 2000 Birth Cohorts

  29. CABG OPERATION & 1-YR MORTALITYNHI Policy Holders, 1999-2000 • Age-adjusted by using 2000 WHO standard population • Source: Wu, Chen, and Chiang – unpublished.

  30. Conclusion

  31. World Trends in Health Care Reform 1971 Canada-NHI 1961Japan-NHI 1989Korea-NHI 1948 UK-NHS 1995Taiwan-NHI 1911Germany-RVO 2001Thailand-Mix 1883 Germany-SI 201? USA-Mix Social Control Welfare State 2005WHO CSDH 1948WHO 1986Ottawa Charter 1978Alma Ata Declaration 1974LalondeReport Laissez-faire Equity in Access Cost Control Efficiency

  32. LESSONS FROM TAIWAN • What worked • Equal access to health care • Prevention of poverty trap • What didn’t work • Social expectations • Social inequalities in health • Necessary but not sufficient

  33. Thank You

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