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TransKorea    [Video] Sick Around the World 세계의 의료보험 제도 (4/5) 대만

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Taiwan's an island nation of about 23 million that became rapidly industrialized and went from poor to rich in about 20 years. And when Taiwan got rich, the government said, "Wait a minute. We need a rich country's health care system." So you know what they did? They set up a committee and they looked all over the world at different health care systems, looking for good ideas, and then designed their own."

In the late 1980s, Taiwanese health care was even worse than the America's is today. About half the population had no coverage at all. Hongjen Chang was one of the officials charged with designing a new health care system from scratch.

Taiwan is a small island. We always look abroad internationally for ideas. Chinese saying, we say, "The track of the previous cart is the teacher of the following cart."

So if the other guy's oxcart has found a good route to universal health coverage, follow those tracks.

Follow those tracks. If they were trapped in trouble, avoid that track. Find a new track.

So they consulted experts from around the world, and asked William Hsiao, a Chinese-born Harvard health economist, to head a blue ribbon panel.

Why do you want to repeat the mistakes other people make? You want to pick up what people have done well and then move beyond that.

Another expert they consulted was Taiwanese-American health economist Tsung-mei Cheng.

How many different countries did they look at, do you know?

Over 10. Maybe 10, 13, 15 countries they looked at. And so in the end, the program that they finally set up in 1995 really is like a car that was made of different parts imported from overseas, but manufactured domestically.

We examine quite extensive the major systems of quite a dozen, Europe, British or France, Germany, the Nordic countries, Swiss or the Dutch--

Well, did you look at--

--America.

--the richest country in the world, the United States?

[laughs] Oh, yes, yes, yes. It was the best system in the world, we thought.

Yeah, you thought. And when you studied it, what did you find?

Well, American is not really a system that you can copy. It's a market. So if you let things happen, it will be like the United States. There are many supporters, but in the end we said, "No, this is not the way we want to go."

They wanted a system that gave everybody equal access to health care, free choice of doctors, with no waiting time, and a system that encouraged lots of competition among medical providers. To finance the scheme, they chose a national insurance system that forced everybody to join in and pay.

But Professor Hsiao thought Taiwan could improve on other countries like Japan and Germany.

We try to correct their mistakes. Japan has many funds, and we unified it. Germany let the rich people opt out. We do not let the rich people opt out. So we're building on what they have done correctly, but trying to overcome their deficiencies.

The solution: To have one government insurer collecting the money and no chance to opt out. The result: A system that works a bit like the U.S. Medicare system for the elderly, and in fact, a lot like Canada's.

It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care, just about everything under the sun.

And to satisfy the patients in Taiwan, there's no gatekeeper and no waiting time. Clinics are open on weekends. This street clinic was bustling at 5:30 on a Saturday afternoon.

If I woke up in Taiwan some morning and my shoulder's really hurting, how long would it take me to see an orthopedic specialist?

We go now. [laughter]

This morning I could see one?

Yeah.

I don't have to go to a GP and get a recommendation?

No, we-- our people don't like the idea of gatekeepers. [laughs] They want to keep-- keep themselves. They want to decide by themselves.

High-tech Taiwan designed its new health system using state-of-the-art information technology. Everybody here has to have a smart card like this to go to the doctor. The doc puts it in a reader, and the patient's history, medications, et cetera, all show up on the screen. And then the bill goes directly to the government insurance office and is paid automatically.

So Taiwan has the lowest administrative costs in world, less than 2 percent. Compare that to the endless paperwork and all the denied claims we get with for-profit U.S. health insurance.

The smart card can also be used in other ways.

If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out and then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well.

That may be too much like Big Brother to get by in the U.S., but surveys show the Taiwanese are highly satisfied with their health care.

How many people in Taiwan every year go bankrupt because of medical bills?

None.

So the patients are safe from bankruptcy. But just like Japan, the system itself is under strain.

How much of the Taiwan's GDP are you spending on health care?

We spend some 6.23 percent.

Do you know the number in America?

Yes, it's about 16 percent.

Sixteen percent. Yes, that's right.

So we spend too much on health care and don't even cover everybody. But the Taiwanese spend too little, less even than Japan. They just don't bring in enough money to pay for all the services they offer.

So actually, as we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers.

Taiwan's politicians are reluctant to increase premiums. They think voters will punish them. So that's their problem. They know the solution is fairly straightforward, increase the spending a little to maybe 8 percent of GDP. Now, there's a problem the U.S. would love to have.

Like the other countries we've seen, Taiwan is struggling to balance the hopes of patients and the expectations of doctors against the price people are willing to pay for health care.

Before leaving Taiwan, I tried some acupuncture for my bum shoulder. I hurt it years ago in the Navy. Of course, Chinese medicine is covered by Taiwan's plan, too.

Taiwan's achievement got me thinking about what it takes to carry out health care reform. But to create a universal health system in an emerging Asian nation is one thing. To get there in a mature free market economy is something else. So my final stop was in a country more like us that did take on health care reform.