Abstract

Universal Health Coverage (UHC) is being embraced globally as an important goal to improve population health.  In 2015, Taiwan National Health Insurance (NHI) celebrated its 20^th anniversary since its historical inauguration in 1995. The single-payer NHI program, operated by National Health Insurance Administration (NHIA), was established through integrating three existing social insurance schemes and extended the coverage to the then uninsured 43% of the population. Taiwan NHI offers comprehensive benefit coverage that includes ambulatory care (Western and Chinese medicines, and dental services) as well as inpatient services. On the service side, Taiwan has a market-oriented health care delivery system, reflecting its free-enterprise economy, as evidenced by the pluralistic organization of health services. Hospital ownership is mixed where public hospitals only account for 35% of all beds. There is no gate keeping mechanism and the insured essentially enjoy complete freedom of choice which is likely a source of overuse.  As a single payer, NHIA has effectively exploited its market power to experiment with various payment reforms in its 20-year history.  NHIA gradually set up separate global budgets for dental services, Chinese medicines, primary care services, and hospital services since 1998.  The annual growth rate of the total NHI budget is negotiated among stakeholders. NHI revenue mainly relies on payroll-based premiums, supplemented by a levy on non-payroll income and government subsidies. In 2014, NHI spent roughly NTD 538 (USD 16.9) billion on medical claims, accounting for approximately 52% of national health expenditures, and in total, Taiwan devoted 6.2% of GDP to health. The NHI program, which provides universal health coverage (UHC) to Taiwan’s population of 23 million, has had a profound impact on Taiwan’s health system.  This presentation will showcase Taiwan’s NHI scheme, the recent financing reform and challenges ahead, in terms of impact of physician supply and long-term care.