Taiwan's recurrent healthcare expenditure as a percentage of GDP stands at 7.5%, placing it among the lower ranks of OECD countries. Healthcare professionals are urging the government to increase investment in the healthcare sector. Former Minister of Health Twu Shiing-jer highlighted that while Taiwan's National Health Insurance (NHI) enjoys high satisfaction, key health indicators such as neonatal mortality rates and average life expectancy lag behind Japan and South Korea. He emphasized the need for both increased revenue and reduced expenses to address these issues, calling for the establishment of a family physician system and the implementation of a per capita payment model. Without these reforms, Twu warned that the ongoing negotiations between the healthcare sector and the government would continue to lack dignity.
The office of Legislator Cheng-Hsu Wan, in collaboration with the Taiwan Society of Health Economics, held a public hearing today titled "Effective Health Investment to Achieve the Healthy Taiwan Goal." Twu Shiing-jer pointed out that 20 years ago, South Korea's average life expectancy was two years lower than Taiwan's. However, by 2022, Taiwan's average life expectancy was two years less than South Korea's—a concerning shift of nearly five years. With national healthcare spending under pressure, Twu criticized the government for hesitating to ask the public for more funding, instead turning to measures like increasing alcohol taxes. He argued that government, citizens, and the healthcare sector must work together to boost health investment; otherwise, current NHI reform efforts would be futile.
Taiwan's neonatal mortality rate has risen from 2.54 per thousand to 3.01 per thousand, while South Korea's rate has decreased by 60% and Japan's by 50%. Twu stated that neonatal mortality rates cannot be falsified, highlighting the challenges in Taiwan's healthcare quality. He noted that insufficient healthcare investment has led to increased neonatal mortality, slower introduction of cancer drugs, and a decline in average life expectancy. Twu questioned, "Is cheaper insurance really better?"
Twu emphasized that preventive medicine can help manage healthcare demand and reduce medical expenses. He argued that NHI is not merely "disease insurance" and should not focus solely on treatment. Promoting preventive medicine and health promotion is crucial for truly conserving NHI resources. Twu called for the establishment of a Preventive Medicine Promotion Committee under the Ministry of Health and Welfare, which would be responsible for policy formulation, supervision, and research on the cost-effectiveness of various preventive measures. He suggested allocating approximately 1% to 5% of the NHI budget as funding for these initiatives.
Twu also mentioned his long-standing advocacy for the implementation of Article 44 of the NHI Act, which calls for the establishment of a family physician system and the adoption of a per capita payment model. He criticized the government for its administrative inertia over the past 13 years. Twu believes that implementing a family physician system along with a per capita payment model would align doctors' welfare with the health of the public, encouraging physicians to actively promote preventive medicine. "This is a behavioral revolution," Twu said, "a revolution in the health behaviors of the government, the medical community, and the public."
Chang Yu-bin, Chief Secretary of the National Health Insurance Administration, acknowledged that Taiwan's healthcare quality metrics lagging behind international standards is a serious issue that requires urgent review. He noted that the NHI Administration is gradually promoting the family physician system and has recently launched the "Everyone's Physician" initiative, which integrates technology to establish a comprehensive family physician platform. Under this system, family physicians will be involved in patient care before referrals to other levels of medical care are made. As for the per capita payment model, the NHI Administration has selected specific disease areas for gradual implementation.
Resource (mandarin): 醫療品質落後日韓 涂醒哲籲落實家醫制推動預防醫學
