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Healthcare system in Taiwan

--National Health Insurance

References : www.nhi.gov.tw

+About TaiwanPopulation: 23,234,936 (world ranking:

51), with 10.9% of people over 65 years

Government: Multiparty democracy, last presidential election:2012

Geography: An island in eastern Asia, On the boundary of temperateness and

subtropical – TyphoonsOn the boundary of Filipino plate and

Eurasian plate - Earthquake

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History: Before 1895: Qing dynasty1895-1945 (end of WWII): Japanese

colonyAfter WWII: Nationalists ruling, with the

constitution found in 1947After 1949: Gradually democratized in a

peaceful pace

+Taiwanese health situation Life expectancy:

Total: 78.48 years Male: 75.66 years Female: 81.53 years

Infant mortality rate: 5.1 deaths/1,000 live births (world ranking: 179) Male: 5.38 deaths/1,000 live births Female: 4.8 deaths/ 1,000 live births

Total death rate: 7.12 deaths/1,000 population (world ranking: 128)

Prevalence of HIV/AIDS (2012): HIV infection: 24,309 AIDS: 9,367

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National Health Insurance (NHI)

Overview

Enrollment

Financing Insured Classification Premium Calculation Copayment System

Payment System

Future challenges

Overview

Started on March 1, 1995

Compulsory social health insurance program for all citizens from birth

Health Insurance IC Card

Second Generation National Health Insurance System

Enrollment

Taiwan (ROC) Citizens

Overseas ROC citizensstay in Taiwan for more than 3

months

Residents from Hong Kong, Macau, China and Other Foreignersstay in Taiwan for more than 6

months

Financing

Primarily funded by the premiums

Other revenues

Premium rates: reviewed and re-calculated every two

years

the premium rates has only been adjusted twice in the system's 15 years of existence4.25% (1995) → 4.55% (September

2002) → 5.17% (April 2010)

Financing - Insured Classification

Financing - Premium Calculation

Financing - Copayment System

Copayment Exemptions catastrophic illnesses living in remote mountain

areas or offshore islands child birth veterans and their

dependents low-income households children under the age of

three registered tuberculosis

patients who receive treatment at specified contracted hospitals

Patients being treated for occupational ailments who are covered by labor insurance

Payment System

Healthcare institutions signed contracts with the BNHI: 92.47%

Early years : “fee-for-service” → spiraling growth of medical cost

Pay-for-performance system (first introduced in 2001) breast cancer therapy, diabetes, asthma and

hypertension treatment

Global Budget Payment System

Taiwanese version of the Diagnosis Related Groups (Tw-DRGs) adopted 111 DRGs into practice for the first year

(2010) and would take 5 years to phase in the complete system (more than 500)

Who is benefited? Reference: Nicole Huang, Yiing-Jeng Chou, et al. The distribution of net benefits under the National Health Insurance programme in Taiwan. Health Policy and Planning 2007:22:49-59

Future challenges

Improving Access to Quality Care in Remote Regions

Expanding Resources to Care for Disadvantaged

Long-term Care Insurance

Making both Ends Meet

Taiwan’s public health challenges…Very low birth rate

8.81 births/ 1,000 population, world ranking: 211

Population growth rate: 0.171%, world ranking: 179

Food security: Cloudy agents contaminated by

plasticizerLeanness-enhancing drug

Thank you for your attention!