Applied Health Economics and Health Policy

, Volume 15, Issue 6, pp 717–731 | Cite as

Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan

Current Opinion

Abstract

The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

Notes

Compliance with Ethical Standards

Funding

No external funding was received for this study.

Conflict of interest

Jesse Yu-Chen Lan declares no conflicts of interest. This paper did not require institutional ethics committee approval.

References

  1. 1.
    World Health Organization. The declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. http://www.who.int/publications/almaata_declaration_en.pdf. Accessed 28 Feb 2016.
  2. 2.
    World Health Organization. Fifty-eighth world health assembly: resolutions and decisions. http://apps.who.int/gb/ebwha/pdf_files/WHA58-REC1/english/A58_2005_REC1-en.pdf. Accessed 28 Feb 2016.
  3. 3.
    United Nations. Adopting consensus text, general assembly encourages member states to plan, pursue transition of national health care systems towards universal coverage. http://www.un.org/press/en/2012/ga11326.doc.htm. Accessed 28 Feb 2016.
  4. 4.
    The constitution of the Republic of China (Taiwan). http://law.moj.gov.tw/Eng/LawClass/LawContent.aspx?PCODE=A0000001. Accessed 28 Feb 2016.
  5. 5.
    The additional articles of the constitution of the Republic of China (Taiwan). http://law.moj.gov.tw/Eng/LawClass/LawContent.aspx?pcode=A0000002. Accessed 28 Feb 2016.
  6. 6.
    Krugman P. Pride, prejudice, insurance. New York Times. 2005.Google Scholar
  7. 7.
    World Health Organization. Research for universal health coverage: World health report 2013. Geneva: World Health Organization; 2013.Google Scholar
  8. 8.
    Gupta V, Kerry V, Goosby E, Yates R. Politics and universal health coverage. N Engl J Med. 2015;373(13):1189–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Esping-Anderson G. Welfare states in transition. Los Angeles: SAGE Publications; 1996.Google Scholar
  10. 10.
    Wilensky H. Rich democracies. Berkeley: University of California Press; 2002.Google Scholar
  11. 11.
    Jacobs L. Institutions and culture: health policy and public opinion in U.S. and Britain. World Politics. 1992;44:179–209.CrossRefGoogle Scholar
  12. 12.
    Catherine J. The pacific challenge: confucian welfare state. In: Jones C, editor. New perspectives on the welfare state. London: Routledge; 1993. p. 199–217.Google Scholar
  13. 13.
    Searle J. The construction of social reality. New York: Free Press; 1995.Google Scholar
  14. 14.
    Hacker J. The historical logic of national health insurance: structure and sequence in the development of British, Canadian, and U.S. medical policy. Stud Am Polit Dev. 1998;12(1):57–130.Google Scholar
  15. 15.
    Immergut E. Health politics: interests and institutions in Western Europe. New York: Cambridge University Press; 1992.Google Scholar
  16. 16.
    Korpi W. Power resources and employer-centered approaches in explanations of welfare states and varieties of capitalism. World Politics. 2006;58(2):167–206.CrossRefGoogle Scholar
  17. 17.
    Deyo F. Beneath the miracle: labor subordination in the new Asian industrialism. Berkeley: University of California Press; 1989.Google Scholar
  18. 18.
    Pierson P. Politics in time: history, institutions, and social analysis. Princeton: Princeton University Press; 2004.CrossRefGoogle Scholar
  19. 19.
    Mahoney J. Path-dependent explanations of regime change. Stud Comp Int Dev. 2001;36(1):111–41.CrossRefGoogle Scholar
  20. 20.
    Lin K. From authoritarianism to statism: the politics of national health insurance in Taiwan [PhD thesis]. New Haven: Yale University; 1997.Google Scholar
  21. 21.
    Wong J. Adapting to democracy: societal mobilization and social policy in Taiwan and South Korea. Stud Comp Int Dev. 2005;40(3):88–111.CrossRefGoogle Scholar
  22. 22.
    Walzer M. Spheres of justice: a defense of pluralism and equality. New York: Basic Books; 1983.Google Scholar
  23. 23.
    World Health Organization. Arguing for universal health coverage. Geneva: World Health Organization; 2013.Google Scholar
  24. 24.
    Cheng T. Reflections on the 20th anniversary of Taiwan’s single-payer national health insurance system. Health Aff. 2015;34(3):502–10.CrossRefGoogle Scholar
  25. 25.
    National Health Insurance Administration. 2015–2016 national health insurance annual report. Taipei: National Health Insurance Administration; 2016.Google Scholar
  26. 26.
    Mahoney J, Thelen K. Advances in comparative-historical analysis. New York: Cambridge University Press; 2015.CrossRefGoogle Scholar
  27. 27.
    Mahoney J, Thelen K. Explaining institutional change. Oxford: Oxford University Press; 2009.CrossRefGoogle Scholar
  28. 28.
    Wolfgang S, Thelen K. Beyond continuity: institutional change in advanced political economies. Oxford: Oxford University Press; 2005.Google Scholar
  29. 29.
    Hacker J, Pierson P, Thelen K. Drift and conversion: hidden faces of institutional change. In: Mahoney J, Thelen K, editors. Advances in comparative-historical analysis. New York: Cambridge University Press; 2015. p. 180–208.CrossRefGoogle Scholar
  30. 30.
    Main economic indicators, Executive Yuan Directorate General of Budget, Accounting and Statistics; Department of Statistics of the Ministry of Health and Welfare, Health Expenditure Statistics (1992–2013). http://www.mohw.gov.tw/CHT/DOS/DM1_P.aspx?f_list_no=557&fod_list_no=365&doc_no=48453&rn=264131283. Accessed 24 Feb 2016.
  31. 31.
    Economic growth rate: national income and economic growth, Directorate General of Budget, Accounting and Statistics. http://www.stat.gov.tw/ct.asp?xItem=37407&CtNode=3564&mp=4. Accessed 24 Feb 2016.
  32. 32.
    National Health Insurance Administration. Actuarial report on NHI premium rates 2009. Taipei: National Health Insurance Administration; 2009.Google Scholar
  33. 33.
    Organisation for Economic Co-operation and Development (OECD). Health statistics 2016. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT. Accessed 17 Aug 2016.
  34. 34.
    Ministry of Health and Welfare (Taiwan). Taiwan Health and Welfare Report 2015. http://www.mohw.gov.tw/MOHW_Upload/doc/2015MOWH.pdf. Accessed 30 May 2016.
  35. 35.
    Directorate General of Budget, Accounting and Statistics, Executive Yuan (Taiwan). Social Indicators of National Statistics 2012.http://eng.stat.gov.tw/lp.asp?ctNode=3480&CtUnit=1344&BaseDSD=7 . Accessed 30 May 2016.
  36. 36.
    Ministry of Health and Welfare (Taiwan). 2014 Statistics of General Health and Welfare.http://www.mohw.gov.tw/en/Ministry/Statistic_P.aspx?f_list_no=474&fod_list_no=5732&doc_no=53363. Accessed 30 May 2016.

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Public Policy and ManagementI-Shou UniversityKaohsiung CityTaiwan, ROC

Personalised recommendations