Plenary Session II (a)
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 20th 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.
Plenary Session II (c)
Abstract
The author reviews major health care reform initiative attempts by the Hong Kong government since the 1990’s. The author applies public choice and other public policy theories to explain the lack of success in these initiatives. The current financing and delivery system is evaluated in terms of its efficiency and its ability to cope with the rapidly ageing population. Government subvention amounts and the number of doctors employed in public hospitals are measured against output. The results of the analyses suggest that, contrary to popular opinion that not enough resources are given to public hospitals, government has, in fact, been providing more resources to the public health care system year after year (measured by subvention amount, doctor to population ratio, doctor to bed ratio, doctor to patient days, etc). Long standing problems, such as waiting time, appear to be worsening despite increases in funding. The results suggest that the structure of the health care system is too acute-centric, and the current funding mechanism creates perverse incentives. The author concludes that Hong Kong is poorly prepared to cope with the rapidly ageing population, and that the quality of care and accessibility to care are likely to further deteriorate. Given the existing constitutional arrangement in Hong Kong, the author recommends reforming the existing tax based financing system instead of launching new initiatives to replace it. The restructuring of some existing funding and administrative responsibilities of relevant public bodies to address the compartmentalization and perverse incentive problems and the establishment of an earmarked government future fund to assure the future viability of the tax-based system are suggested as the way forward.
Plenary Session II (b)
Abstract
Since launching the health care reform in 2009, China has made significant progress in establishment of a basic health insurance system covering both urban and rural residents. China’s social health insurance schemes – including the Urban Employee Basic Medical Insurance scheme (UEBMI; launched in 1998), Urban Resident Basic Medical Insurance scheme (URBMI; launched in 2007), and the New Rural Cooperative Medical Scheme (NRCMS; launched in 2003) – have rapidly expanded during the past decade and now cover almost the whole Chinese population. The UEBMI scheme is mandatory for the employees and retirees in urban areas, with premiums paid by both employers and employees, covering outpatient expenditures, inpatient services and designated pharmacies. Those not covered by the UEBMI scheme could join the voluntary URBMI scheme jointly financed by enrollees and the government. Rural residents enroll voluntarily in the NRCMS scheme in the units of families, financed by the enrollees and the government. Payroll taxes are the main funding source for the UEBMI scheme, and government subsidies are the major funding sources for the URBMI scheme and NRCMS. In recent years, government health funding increased obviously and China’s total health expenditure as a percentage of GDP has attained 6% in 2015. Proportion of out-of-pocket payments in total health expenditures has been rapidly reduced after introduction of the social health insurance schemes. Due to the complexity and systematic nature, health care system reform in China is faced with many challenges that require persistence and development. The reform needs to go further in promoting comprehensive reform of health insurance, medical services delivery, and integrating basic health insurance schemes.