Jump to content

Healthcare in Taiwan

From Wikipedia, the free encyclopedia

Ministry of Health and Welfare (Taiwan)
Emblem of National Health Insurance

Healthcare in Taiwan is administered by the Ministry of Health and Welfare of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease.[1] In 2023, Taiwan had 2.3 physicians and 7.3 hospital beds per 1,000 population.[2] There were 476 hospitals and 23,421 clinics in the country. Per capita health expenditures totaled US$2,522 in 2023.[3] Health expenditures constituted 7.8% of the gross domestic product (GDP) in 2023; 63% of the expenditures were from public funds.[3] Overall life expectancy in 2025 is 80.94 years.[4]

Recent major health issues include the SARS crisis in 2003, though the island was later declared safe by the World Health Organization (WHO).[1] In 2020, Taiwan was hit by the COVID-19 pandemic, experiencing four waves of widespread community transmission between January 2020 and March 2023. It successfully contained the disease in the first two years but shifted its control strategy from containment to mitigation in April 2022 when Omicron infections surged in the community.[5]

According to the Numbeo Health Care Index in 2025, Taiwan has the best healthcare system in the world, scoring 86.5 out of 100,[6] a slight increase from 86 the previous year.[7] This marked the seventh consecutive year that Taiwan has ranked first in the Numbeo Health Care Index.[8] The 2024 edition of the CEOWORLD Magazine Health Care Index also ranked Taiwan first among 110 countries surveyed, with a score of 78.72 out of 100.[9]

National Health Insurance

[edit]

The current healthcare system in Taiwan, known as National Health Insurance (NHI, Chinese: 全民健康保險), was instituted in 1995. NHI is a single-payer compulsory social insurance plan that centralizes the disbursement of healthcare funds. The system promises equal access to healthcare for all citizens.[10] Population coverage reached 99.9% by the end of 2023. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002. Then, in 2013, the second-generation NHI system was launched to increase the funding pool. Supplementary premiums were levied at a 4.91% rate[11] on high bonuses, professional fees, investment interest, stock dividends, and rent to ensure greater fairness in premium contributions.[12]

The implementation of universal healthcare created fewer health disparities for lower-income citizens in Taiwan. Additionally, life expectancy increased more in health class groups that had higher mortality rates before national health insurance was introduced.[13] Life expectancy in Taiwan was 80.2 years as of 2023.[14] Infant mortality rate was low, at only 4.3 deaths for 1,000 live births in 2023.[14] Fertility rates are very high and stable.[15]

History

[edit]

Modern medicine only reached Taiwan after the Japanese invasion in 1895. Disease was one of the biggest challenges faced by the Japanese in their early years on Taiwan. A Japanese Prince who was part of the invasion force died of malaria. The Japanese introduced western medicine and modern sanitation practices. The introduction of water purification plants reduced the spread of cholera and other diseases. Communicable disease was a major issue, a plague outbreak lasted from 1898 to 1918. Malaria was reduced through the draining of wetlands and the clearing of bamboo forests.[16]

Further information: Healthcare in China

Following the retreat of the KMT to Taiwan healthcare consisted of a mix of Japanese era institutions and military/veterans institutions which the KMT brought with them along with 1.5 million troops and civilians. Healthcare continued to be almost entirely a government concern until the 1970s when a number of Taiwan’s leading industrial groups opened hospitals.[16]

In July 2013, the Department of Health was restructured as the Ministry of Health and Welfare.[17]

Healthcare reform

[edit]
National Health Insurance Administration

Taiwan started its health reform in the 1980s after experiencing two decades of economic growth, the period often referred to as the Taiwanese Miracle.[18]

In 1987, the government ended the martial law that mobilized the governmental departments. The government set up a planning commission and studied other countries' healthcare systems. Taiwan looked at more than ten countries and combined their best qualities to form their own unique system.[19] Healthcare bills were fast-tracked through the Legislative Yuan between 1993 and 1994.[19][20]

On 1 March 1995, Taiwan formed the National Health Insurance (NHI) model, following the passage of the National Health Insurance Act on 19 July 1994.[21] In a 2009 interview, Michael Chen, vice president and CFO of Taiwan's National Health Insurance Bureau explained that one of the models investigated was the United States and that fundamentally, NHI "is modeled after Medicare [in the USA]. And there are many similarities — other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance."[22][23]

NHI delivers universal coverage offered by a government-run insurer, covering outpatient visits, inpatient care, dental care, traditional Chinese medicine, renal dialysis, and prescription drugs.[24] The working population pays premiums split with their employers; others pay a flat rate with government help and the poor or veterans are fully subsidized. There are no financial barriers to receiving the medical care required by an individual.[24] That way, Taiwan's citizens are less prone to bankruptcy as a result of medical bills, according to Hongjen Chang, one of the architects of the system.[25]

Under this model, citizens have free range to choose hospitals and physicians without using a gatekeeper and do not have to worry about waiting lists. NHI offers a comprehensive benefit package that covers preventive medical services, prescription drugs, dental services, Chinese medicine, home nurse visits and many more. Working people do not have to worry about losing or changing their jobs because they will not lose their insurance. Since NHI, the previously uninsured have increased their usage of medical services. Most preventive services are free such as annual checkups and maternal and child care. Regular office visits have co-payments as low as US$5 per visit. Co-payments are fixed and unvaried by the person's income.[26]

≈ 1906 ≈ 1998[27] ≈ 2012[28][29] ≈ 2023[14]
Life expectancy M: 39 years; F: 43 years M: 72 years; F: 78 years M: 76 years; F: 83 years M: 76.9 years; F: 83.7 years
Infant mortality 84.1 per 1,000 live births 6.14 per 1,000 live births 5.10 per 1,000 live births 4.3 per 1,000 live births
Maternal mortality 7.6 per 1,000 live births 0.9 per 1,000 live births

By 2023, 99.9% of the population were enrolled in the program. Every enrollee has a Health IC smart card. This credit-card-size card contains 32 kilobytes of memory that includes provider and patient profiles to identify and reduce insurance fraud, overcharges, duplication of services and tests.[30] The physician puts the card into a reader and the patient's medical history and prescriptions come up on a computer screen. The insurer is billed the medical bill, and it is automatically paid. Taiwan's single-payer insurer monitors standards, use and quality of treatment for diagnosis by requiring the providers to submit a full report every 24 hours. This improves quality of treatment, limits physicians from over-prescribing medications, and keeps patients from abusing the system.[25][31]

Patients have largely been satisfied with the system, with satisfaction rates consistently reaching 90% in recent years.[14] However, doctors have been more dissatisfied because fee premiums are controlled as well as selection of services provided under the system. Also, doctors could be heavily penalized for a wide variety of reasons such as seeing too many patients or offering too many services even if patients and services were valid. This system has led to protests by healthcare providers. At the beginning of 2006, patients' satisfaction decreased to the mid-60% range because the program needed more money to cover its services. Since then, satisfaction has risen steadily to 90%. Enrollees are satisfied with more equal access to healthcare, have greater financial risk protection and have equity in healthcare financing.[25]

Taiwan has the lowest administration cost in the world of 2%.[25] Before NHI, Taiwan spent 4.7 to 4.8% of GDP on healthcare. The figure increased to 5.39% a year after NHI was introduced and, by 2023, reached 7.8%, or US$2,522 per person.[3] Before NHI, the average annual rate of increase was around 13%. After a global budget payment system was introduced in 2002, the annual rate of growth in medical expenditure has remained steady at around 5%.[14]

Facilities and coverage

[edit]

As of 2023, Taiwan had a total of 23,896 hospitals and clinics, as categorized below:[2]

Medical facility Number
Western medicine hospital 471
Western medicine clinic 12,200
Dental hospital 1
Dental clinic 7,026
Chinese medicine hospital 4
Chinese medicine clinic 4,194

Basic coverage areas of the insurance include:

  • In-patient care
  • Ambulatory care
  • Laboratory tests
  • Prescription and over-the-counter drugs
  • Dental services
  • Mental Illness
  • Traditional Chinese medicine
  • Home care
  • Preventative services (check-ups, prenatal care, pap smears)

Problems

[edit]

Even with all their success in their healthcare system, Taiwan has suffered many misfortunes. From 1996 to 2008, the average annual growth rate of expenditures was 5.33%, which outstripped the growth rate of revenue at 4.43%.[24] The revenue base is capped so it does not keep pace with the increase in national income.

There is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. There is also a shortage of nurses.[24] Patients visit the doctor more frequently causing doctors to keep visits to about 2 to 5 minutes per patient.[32] Also, the system is based on a global budget, meaning it has no regard for faculties of risk (surgery, internal medicine, gynaecology, pediatrics, emergency), which affects the medicine, operation and diagnostic tools (X-ray vs. MRI) prescribed.[33]

Due to a decrease in funds available, and with no systems in place to screen patients, all patients will rush to hospitals regardless of terminal patients or general cold, many smaller, but long-serving district hospitals are forced to downscale, or close down and be demolished.[34][35]

Regional disparities

[edit]
Further information: North–South divide in Taiwan § Life expectancy

Although the National Health Insurance program has improved healthcare access across Taiwan, regional disparities in medical resource allocation persist between urban and underprivileged areas.[36] Northern Taiwan has a higher population concentration compared to the rest of the country and, therefore, is home to more medical facilities and health professionals.

Health professionals per 10,000 people[2]
Health professional Western medicine physican Dentist
Nationwide 122.47 23.04 6.95
Taipei City 210.92 46.28 13.84
Taichung City 137.81 25.44 7.59
Kaohsiung City 141.02 26.97 7.27
Taitung County 107.45 15.69 3.64

Electronic health records

[edit]
Main article: Electronic health record

Taiwan implemented a national electronic health record system beginning with a 3-year plan in 2009.[37] All residents have a national health insurance card that allows health providers to access their medical information, including visits, prescriptions, and vaccinations.[38]

Nursing

[edit]
Main article: Nursing in Taiwan

The Ministry of Health and Welfare is in charge of nursing regulation in Taiwan. Nursing is a licensed profession. A nurse specialist practitioner system was introduced in 2006 to enhance the professional competence of nursing staff and improve the quality of health care. In 2023, Taiwan had 187,725 nurses and 14,383 nurse practitioners.[14]

Life expectancy and infant mortality data

[edit]
Historical development of life expectancy in Taiwan
Period Life expectancy in
years[39] 		Period Life expectancy in
years[39]
1950–1955 58.2 1985–1990 73.4
1955–1960 62.9 1990–1995 74.4
1960–1965 65.0 1995–2000 75.2
1965–1970 66.9 2000–2005 76.9
1970–1975 69.4 2005–2010 78.2
1975–1980 70.8 2010–2015 79.2
1980–1985 72.1 2015–2020 81.0

See also

[edit]

References

[edit]
  1. ^ a b "Taiwan country profile" (PDF). Library of Congress Federal Research Division. March 2005. Archived (PDF) from the original on 2015-03-29. Retrieved 2008-05-04. This article incorporates text from this source, which is in the public domain.
  2. ^ a b c 統計處 (2024-07-30). "Statistics of Medical Care Institution & Hospital Utilization, 2023". 統計處. Retrieved 2025-05-07.
  3. ^ a b c 統計處 (2025-03-18). "2023 NHE Statistical Tables". 統計處. Retrieved 2025-05-07.
  4. ^ "Life Expectancy by Country and in the World (2025)". Worldometer. Retrieved 2025-05-07.
  5. ^ Chen, Wan Chin; Huang, Angela Song-En (2024-01-01). "COVID-19 public health surveillance and response in Taiwan: From containment to mitigation". Journal of the Formosan Medical Association. 123: S17 – S26. doi:10.1016/j.jfma.2023.08.016. ISSN 0929-6646.
  6. ^ "Health Care Index by Country 2025". www.numbeo.com. Retrieved 2025-05-07.
  7. ^ "Taiwan's healthcare ranked No. 1 globally by Numbeo | Taiwan News | Feb. 5, 2025 12:35". taiwannews.com.tw. 2025-02-05. Retrieved 2025-05-07.
  8. ^ "Advancing health equity as Taiwan's NHI turns 30 – iWitness News". www.iwnsvg.com. 2025-05-14. Retrieved 2025-05-16.
  9. ^ Wilson, Despina (2024-04-01). "Countries With The Best Health Care Systems, 2024". CEOWORLD magazine. Retrieved 2025-05-07.
  10. ^ Fanchiang, Cecilia."New IC health insurance card expected to offer many benefits" Archived 2008-06-06 at the Wayback Machine, Taiwan Journal, January 2nd, 2004 Accessed 28 March 2008
  11. ^ 衛生福利部 (2012-04-03). "有關二代健保何時實施問題". 衛生福利部. Retrieved 2025-05-16.
  12. ^ Tsuei, Sian Hsiang-Te (2024-11-01). "Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities". Journal of the Formosan Medical Association. Challenges and Resilience of Taiwan’s Health Care System after Covid-19. 123: S180 – S187. doi:10.1016/j.jfma.2024.07.030. ISSN 0929-6646.
  13. ^ Wen, Chi Pang; Tsai, Shan Pou; Chung, Wen-Shen Isabella (19 February 2008). "A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity". Annals of Internal Medicine. 148 (4): 258–67. doi:10.7326/0003-4819-148-4-200802190-00004. PMID 18283203.
  14. ^ a b c d e f "2024 Taiwan Health and Welfare Report". service.mohw.gov.tw. Retrieved 2025-05-09.
  15. ^ "East Asia/Southeast Asia :: Taiwan — The World Factbook - Central Intelligence Agency". www.cia.gov. Retrieved 2018-12-02.
  16. ^ a b Rickards, Jane (25 November 2020). "Tracking Taiwan's Medical History". topics.amcham.com.tw. Topics.
  17. ^ Hsiao, Alison (24 July 2013). "Ministry of Health and Welfare completes restructuring". Taipei Times. Retrieved 5 November 2013.
  18. ^ Reid, T.R. (2008). "FRONTLINE: Sick Around the World". Public Broadcasting Service. Archived from the original on 2017-08-26. Retrieved 2017-08-29.
  19. ^ a b Reinhardt, Uwe E. (12 January 2008). "Humbled in Taiwan". BMJ. 336 (72): 7635. doi:10.1136/bmj.39450.473380.0F. PMC 2190287. PMID 18187722. After visiting the health systems of numerous other nations, Taiwan's policy planners used the insights gained to develop what has been described as "a car made from many parts produced abroad but assembled in Taiwan."
  20. ^ Scott, Dylan (13 January 2020). "Taiwan's single-payer success story — and its lessons for America". Vox. Retrieved 1 November 2020.
  21. ^ Han Cheung (14 July 2019). "Taiwan in Time: Saying no to universal healthcare". Taipei Times. Archived from the original on 14 July 2019. Retrieved 15 July 2019.
  22. ^ "Jonathan Cohn interviews Taiwan's Dr. Michael Chen: The Case for Single-Payer Health Care (Transcript)". Archived from the original on 2009-09-21. Retrieved 2009-09-11.
  23. ^ "TRNtv:Jonathan Cohn interviews Taiwan's Dr. Michael Chen (Video)". Retrieved 11 September 2009.[dead link]
  24. ^ a b c d Cheng, Tsung-Mei (14 May 2015). "Taiwan's health care system: The next 20 years". Brookings. Archived from the original on 9 December 2017. Retrieved 2017-12-08.
  25. ^ a b c d "Taiwan Takes Fastrack to Universal Health Care". All Things Considered, NPR. 2008-04-15. Archived from the original on 2008-08-13. Retrieved 2008-10-05.
  26. ^ Jui-Fen Rachel Lu; William C. Hsiao (2003). "Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan". Health Affairs. 22 (3): 77–88. doi:10.1377/hlthaff.22.3.77. PMID 12757274.
  27. ^ Source: Lee, Ming-Liang (2001-05-14). Health Care in Taiwan — Past, Present and Future. 54th World Health Assembly. Archived from the original on 2007-05-07. Retrieved 2008-05-01.
  28. ^ "The World Factbook: Life Expectancy at Birth". The World Factbook. Central Intelligence Agency. Archived from the original on 20 January 2016. Retrieved 20 August 2012.
  29. ^ CIA on Infant Mortality (2009)
  30. ^ Chen, Yuh-Ning (September 2003). "Taiwan'S Health IC Smart Card Security and Privacy Policy" (PDF). Archived (PDF) from the original on 2008-09-05. Retrieved 2008-03-16.
  31. ^ Pang Wen Chi, Pou Tsai Shan, Isabella Chung Wen-Shen (2008). "A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity". Annals of Internal Medicine. 148 (4): 258–67. doi:10.7326/0003-4819-148-4-200802190-00004. PMID 18283203.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  32. ^ Gunde, Richard (2004-09-30). "Healthcare in Taiwan: Successes and Challenges". Archived from the original on 2016-04-08. Retrieved 2016-03-29.
  33. ^ TVBS NEWS (2015-05-19), 台灣健保20年「收費低」病患享受醫師災難, retrieved 2017-10-02
  34. ^ 東森新聞 CH51 (2016-05-28), 「厝邊好醫生」消失危機！健保20年 小醫院倒一半【3600秒】, retrieved 2017-10-02{{citation}}: CS1 maint: numeric names: authors list (link)
  35. ^ Wu, Tai-Yin; Majeed, Azeem; Kuo, Ken N. (2010). "An overview of the healthcare system in Taiwan". London Journal of Primary Care. 3 (2): 115–119. doi:10.1080/17571472.2010.11493315. PMC 3960712. PMID 25949636.
  36. ^ Hsieh, Chia-Ling; Chung, Chia-Yu; Chen, Hsin-Yu; Shieh, Shwn-Huey; Hsieh, Ming-Shun; Hsieh, Vivian Chia-Rong (2023-09-11). "Bridging geographical disparities across 368 townships with healthcare system and socioeconomic factors in Taiwan". Scientific Reports. 13 (1): 15007. doi:10.1038/s41598-023-42124-y. ISSN 2045-2322. PMC 10495323. PMID 37696847.
  37. ^ Li, Yu-Chuan (Jack); Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei (2015-08-01). "Building a National Electronic Medical Record Exchange System – Experiences in Taiwan". Computer Methods and Programs in Biomedicine. 121 (1): 14–20. doi:10.1016/j.cmpb.2015.04.013. PMID 26001420.
  38. ^ "The 2020 International Profiles of Health Care Systems: A Useful Resource for Interpreting Country Responses to the COVID-19 Pandemic". Commonwealth fund. 10 June 2020. Retrieved 24 June 2020.
  39. ^ a b "World Population Prospects – Population Division – United Nations". Retrieved 15 July 2017.
[edit]
Wikimedia Commons has media related to Healthcare in Taiwan.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Healthcare_in_Taiwan&oldid=1291101088"