What can We Learn from Taiwan’s Single Payer Health Care System
Healthcare in Taiwan is considered as one of the most highly efficient health care systems in the world. Every citizen in Taiwan is fully covered and there is no such thing as pre-existing health condition. If you are an American living in the United States, you probably would know how wonderful the healthcare in Taiwan sounds, because in Taiwan, no matter you have a decent job or are jobless, you are always covered by so-called “Universal Health Care”. It’s truly universal. Everyone is in and no one is out. The rate you pay might be slightly different but the monthly premium is really affordable, for most citizens, they pay less than US$50 per month and they have every right to access the health care system in Taiwan.
Health Care Is A Human Right, Not A Privilege
When you lose your job, no matter you quit or get laid off, you don’t want to lose the right to see a doctor. Especially when you are really sick, you seriously don’t want to worry that if the visiting to the hospital would cost you a fortune. Life is so precious and you don’t want to choose between your life and the ridiculous medical bill.
The other good thing about health care in Taiwan is you don’t need to see your primary physician and ask him to refer you to some specialists. The process may take a while if you always have to see your primary doctor first. All you need to do is present your health card to ANY of the clinics or hospitals. It’s that simple.
Healthcare in Taiwan is such a success and so affordable. Even some tourists go to Taiwan to see some specialists. Yes, tourists can pay cash to see the doctors when they are sick or the specialists for some plastic surgery or Botox injection. Paying cash is a little bit higher than paying by presenting your health card, which fees will be deducted from your bank account. I heard that tourists from Canada or China take advantage of (not sure if I should use the word “abuse”) the health care in Taiwan.
Program overview – A Health Care System which Keeps Evolving
Anyone who gets sick at any moment, they can count on Taiwan’s National Health Insurance that has been running since March 1, 1995, to give health care insurance for those who are living in the country. This national health insurance is kind of important program that must be done since she or he was born. The program was started by mutual assistance concept and the health care service will be given to the users based on the regulation of the insured paying.
According to the regulation, all of the communities in Taiwan either foreigners who are living in Taiwan with ARC, as known as Alien Resident Certificate, or the official residency are obliged to join the program no matter how old he or she is, no matter what his or her occupation, gender, or anyone who belongs to Taiwan Citizens. Moreover, the health care insurance program will always be valid as long as he or she is still alive and stays in Taiwan. In this case, for those who have enrolled the program will never be able to withdraw unless they lose their insurance eligibility or when you move overseas and do not belong to the citizen of Taiwan anymore.
Suppose some of the people get sick and need medical treatment, the government will use the premiums in which it can help them to get medical treatment according to the contracted health care insurance enrolled. For example, when you are sick, then you will get medical treatment service according to the condition of your health. It means that when you pay the monthly premium National Health Insurance service on time, then you will also help the people who also belong to the program from the same premium service and vice versa.
After years of consulting health care experts and researching other health care systems worldwide, Taiwan’s single-payer health care system has been almost 20 years and has been a great success. From what I can see, the hospitals and clinics deliver great health care services in a very timely fashion and there is minimal wait time. With such a great health care system in Taiwan, Taiwanese stay healthy and competitive and their technology keeps advancing to a newer level.
Healthcare Insurance Enrollment Process
Infants or Newborn Babies
Any infants who are just born and get a birth certificate, then their parents will take responsibility for the National Health Insurance program. The father or mother must enroll the program for the babies by using the father or mother’s insurance registration and they have a responsibility to pay the monthly premium.
Any students can register the National Health Insurance program despite he or she has no profession or does not make money yet through the parents’ permission. Suppose they do not have parents to count on, then they can register as their paternal and maternal grandparent dependent. If they also do not grandparents, then they have to register the program based on their hometown or village in which they will hold the household registration.
Renewal Insurance for Students Who Reach the Age of 20
Any unemployed students who have reached 20 years old shall be still defendant of their parents to get National Health Insurance cover. In this case, the insurance registration organization has responsibility for the registration in which they have to submit the new form of insurance renewal on the last date of the month where they will turn 20 years old. They have to submit the form and other student proof documents to the National Health Insurance Administration where they enroll and to get more insurance coverage extension when they start to turn 20.
Part-Time Job Students
Any students who work in a certain company and belong to part-time job student, they also have to register the health insurance program through their employers’ management.
Any students who join full-time job or who have a job during the winter and summer holiday no longer than 3 months and will get back to school after the work, they do not have to update or renew their registration status when they are on duties.
Any students who join vocational training program who are employed at factories have a chance to enroll in the program at the moment they get back to school.
The Employed Persons
Anyone who has a job or works at a certain company needs to register in the National Health Insurance program by the use of company authorities.
Anyone who runs a company has a chance to register the program by their own way. Suppose they have other jobs, then they can count on their primary employers to register.
Employees with Fixed Employers
Anyone who works at a company with fixed employers, he or she has to register through the employers.
Employees without Fixed Employers
Anyone who becomes part of occupational union members such as fisherman and farmer member or for those who become part of fishing and farming related job have to register the Nation health Insurance program via the fishermen or farmer’ associate or occupation union.
Working with Two Jobs
Anyone who work at more than one office, then he or she must also register in the program through their main employer based on the duration of the work hours or it can also be determined by the income.
Individual on Unpaid Leave
For those who are in this condition, they can register through their employers and if they wish, then they can continue to enroll the program by using their salary.
Parents on unpaid parental Leave
Newborn babies parents who get unpaid parental leave based on the Gender Equality in Employment Act are able to register through their employers according to the original salary or through
The Unemployed Person
- For those who do not have any jobs and considered as dependents must be registered in the National Health Insurance program through the other employed partners or through their siblings.
- Suppose registration through direct blood relative or through spouses cannot be done, or for those who have retired from public enterprise, government office, or public school but they wish to enroll the program by their own way, then they have to enroll it at the village administrative office or the area in which they register their household.
- Anyone who has relation to veterans may register the program in the township or village administrative office where they registered their household
Healthcare Premium Payment
The employees, employers, and the government will take responsibility to pay the premiums in each month as the National Health Insurance program financial source. These premiums will be paid by anyone who is registered in the program and then the collected money will be used to help other registered members who get sick. In this case, the premiums can be used only to pay the actual medical expense and the administrative cost as well as the employee salary of the National Health Insurance program will be handled by the government itself.
Prepaid Medical Cost Reimbursement
If you have already been registered in the insurance program and you get health issue, then you can some documents needed in order to perform reimbursement request that can be done in the regional division of the National Health Insurance Administration. The administration will grant your request based on the audit results.
- Suppose your registered sibling get an emergency condition and need an immediate medical treatment, then you could not bring him or her to the National Health Insurance contracted hospital in time, but you can take him or her to get emergency treatment at a non-NHI contracted hospital that is located in your region. Or for those who get injured or sick that needs an immediate treatment while they are not in Taiwan, they need to visit the local hospital but the NHI will not be valid before you go back to Taiwan.
- You got medical attention at NHI hospital when the payment was on hold you have done the insurance premium payment as well as other fees incurred at that time.
- You looked for medical attention at a certain Hospital that incorporates with NHI but you should spend your money for the medical expense first because of some reasons that cannot be granted for you, you did not accept any refunds in the period of medical facility refund in which 10 days during the treatment or submit your ID document NHI card before you returned home from the hospital in which some of the people have to pay the medical expense because of their own mistake, the NHI will still be checking the payment of the premiums, getting a health problem that is categorized as catastrophic disease after returned from the hospital, a household with low income or a veteran, the holder of disability certificate that cannot show their identity when the treatment starts, or someone who got tuberculosis.
- You have a catastrophic illness and you apply for it while you get medical treatment in the hospital but you will be accepted after you get out of the hospital and the co-payment refund will not be filed with the hospital in the determined time which is 10 days after the date of the treatment.
Staying Overseas for More than Six Month, What to do?
For those who are planning to go to other countries for longer than six months, they can keep their NHI registration or they can also stop the coverage.
Keep the Insurance Coverage
If you decide to keep the coverage while you plan to go abroad for six months or more, then you do not need any applications to be completed, but you have to pay the premiums each month despite you are in other countries. In this case, you can get emergency procedure but you have to reimburse for the expense they have paid.
Stop the Insurance Coverage
- If you want to stop the coverage of the insurance during going overseas, you have to fulfill and submit a form for insurance suspension application a few days before you go abroad. After the form application is submitted, then you do not need to pay for the premiums and the insurance coverage is no longer valid. You can use your citizen digital certificate if you want to stop the insurance coverage online or your NHI card via the network of the NHI.
- Stopping or suspending the insurance coverage will not burden you the premium payment anymore, but you have to keep in mind that after you get back to Taiwan, then you must restore the coverage by filling the form. You will be registered in the NHI program again. However, if have already suspended the insurance coverage and you get back to Taiwan before reaching 6 months, then you must pay the premium starting from when you have left the Taiwan a few months before.
- You have to follow the appropriate procedure when you plan to go overseas for more than six months in which you cannot abort the suspended coverage and make reimbursement request while you are in other countries but you can still restore the coverage after you get back to Taiwan.
- If you have already stopped or suspended the insurance coverage or you want to suspend the coverage while you are overseas starting January 1, 2013, you can only stop the coverage after you get back to Taiwan and reinstated the coverage for 3 months.
Registration for Prisoners
Any prisoners who are currently staying in jails have got NHI coverage starting from January 1, 2013, because all of the prisoners only have limited access and no freedom to do anything including getting medical treatment which is also restricted. In this case, the sick prisoners have to get medical treatment at any clinics in the prison but if they need to be transferred, they may get medical treatment outside the prison under the security.
Insurance Eligibility Loss
You are no longer part of the NHI program and if you have been registered, then the program will no longer valid due to the several conditions:
- For those who are no longer seen in Taiwan or gone away with no reasons or for those who are missing because of natural disasters, then the insurance coverage can be canceled or withdrawn since the day they are noticed to be lost.
- If someone does not belong to Taiwan citizenship anymore, or moves abroad, or his or her ARC is expired, then the official government has right to withdraw the membership of NHI.
Registering Again After Staying Overseas for Long Period of Time
If you have moved from Taiwan and stay overseas for more than 2 years, then you decide to get back to Taiwan and want to live in Taiwan again, then you can get NHI coverage after six months you settle your household registration.
- If you have stayed overseas for less than 2 years and you get back to Taiwan, then you can have a chance to enroll NHI according to the current regulation as long as you still have household registration.
- If you moved to other countries less than 2 years and you have canceled the household registration and you wish to get back to Taiwan, then you have to settle the household registration again before you enroll National Health Insurance program.
- If you decide to leave Taiwan and you finally stay overseas for more than 2 years and want to get back to Taiwan while your NHI and household registration are no longer valid, then you have to resettle your household registration and then you can wait for 6 months so that you can enroll the NHI program again.
Not many people in the world know how successful the Taiwan’s health care is. Most people know there are universal health care systems in Canada, United Kingdom and Austria.
Let’s explore how Taiwan’s government implemented this “audacious” health care system 20 years ago. In 1995, Taiwan’s economy is picking up slowly but surely because of the stability relationship between Taiwan and China. The Taiwanese government was launching some great projects to enhance their infrastructure throughout entire Taiwan. After the strong economic growth, people begin to worry about the condition of their own health and demand a better health care coverage, so the citizens and lobbyists begun to push the legislators to implement a universal health care system and let Taiwan’s government to run the system, which is “single-payer” health care system.
Before initiating this universal health care, 41% of Taiwanese is uninsured. For those who are insured, they were insured because they have a decent job in a government, organization, which means if they lose their job one day, they pretty much would become uninsured like those who were uninsured. Ironically, this is the situation of the United States, who is the most powerful countries in the world but their health care system is AT LEAST 20 years behind this developing country, Taiwan.
As a result of mandatory enrollment of the new health care system, elders and children are fully covered and almost 100% of its citizens and residents are fully insured.
Jerry Chang has lived in New York for about 10 years. He has a steady job with health insurance but he still pays monthly premium to keep his health insurance in Taiwan. Why does he need two health care insurances at the same time. Is this a wise move to keep Taiwan’s national health insurance while he is in the United States? What are his concerns and worries? Let’s compare the differences of the health care systems in Taiwan and in the United States.