Ms. Chang Bo-ya (張博雅), President of the Control Yuan, who was the Health Minister in 1995 when the National Health Insurance (NHI) Program was launched;
Mr. Chiang Been-huang (蔣丙煌), Minister of Health and Welfare,
Professor William Hsiao (蕭慶倫), from Harvard University,
Professor Uwe Reinhardt, from Princeton University,
House of Councillors Member Keizo Takemi, from the Japanese parliament;
Government representatives, scholars and experts from around the world,
Mr. Huang San-kuei (黃三桂), Director General of the National Health Insurance Administration,
Distinguished guests, ladies and gentlemen:
Good morning!
I'm very happy to be here for today's symposium, sponsored by the Ministry of Health and Welfare's National Health Insurance Administration, marking the 20th anniversary of Taiwan's NHI Program.
First of all, on behalf of the government and people of the Republic of China, I'd like to welcome the government representatives, experts, and scholars who have made the trek to Taiwan from 20 countries around the world. This is a forum for all of you, to share your professional expertise and innovative ideas with us. Let me first discuss the significance and value of the NHI Program.
In 1995, to promote social justice and ensure our citizens' fundamental right to health care, we launched the NHI Program, providing the public with medical insurance services. In two decades since then, the program has protected peoples' right to genuine, equal access to healthcare. At the same time, national health insurance has addressed a serious social issue, diminishing the chance that serious illness will lead to poverty. This gives the people of Taiwan a sense of security, knowing that they always have access to dependable medical care at a reasonable and affordable cost.
Since its inception, Taiwan's NHI program has produced many concrete and positive results. Coverage now exceeds 99.9% of the population, with 93% of hospitals and clinics participating. This has created an exceptionally convenient healthcare environment that’s accessible to everyone, including resident foreigners.
At the same time, the NHI system actively cares for the most vulnerable members of our society. Each year, the government guarantees medical care through budget allocations that subsidize insurance premiums for the underprivileged. This ensures that no one will be deprived of medical care due to a lack of funds. Through these subsidies, the government provided NT$27.7 billion—which is about US$9.2 billion—in aid to 3.2 million people last year, which helped us achieve our stated goal to make healthcare universally accessible.
Under our current system, for every 100 dollars that citizens pay for NHI, an average of 28 dollars is used to help the 4% of program participants who suffer major injuries or illnesses. Thirty-four dollars is used to provide medical care for the 11.6% of participants 65 years of age or older. The program thus makes a contribution that people can really feel, lightening the financial burden of families caring for patients, and promoting overall social welfare.
Since the NHI system was implemented, the average life expectancy of our citizens has also increased by more than 7 percent, from 74.5 years in 1995 to 80 years in 2013.
Given the concrete benefits that I've just cited, it's no surprise that the health insurance system is popular with the general public, with approval ratings always hovering around 80 percent.
Let me just give you a story I was told by a friend of mine who's from a small town on the southern tip of Taiwan. When he was small, more than 50 years ago, people who were seriously ill or injured could do nothing but go home and quietly wait for the last moment to come if they could not afford the bond required by the hospital to make sure that the patient would pay their bill. In other words, in those times, some hospitals required patients with serious illnesses or injuries to post a bond before they would start the operation. So the NHI Program not only gives us pride, but most importantly, a sense of security. Seven years ago, when Taiwan was severely affected by the financial tsunami, the NHI Program functioned exactly like a safety net that made people feel financially and psychologically secure, even when they were laid off.
The hallmarks of Taiwan's NHI system are low premiums, high efficiency, and high-quality medical service. So you could say that the system has set new global standards in five areas: greatest breadth of coverage, greatest convenience, greatest freedom, most economical, and highest satisfaction rate. So we are grateful for all the attention and praise we’ve received from the international community.
Princeton University Professor Paul Krugman, the 2008 Nobel laureate in Economic Sciences, has publicly praised our NHI system for extending coverage to the entire population—without significantly increasing medical costs.
In 2008, America's Public Broadcasting Service filmed a documentary entitled "Sick Around the World." The film looked at healthcare delivery models in Taiwan and other developed countries. In 2012, four major international media outlets—The New York Times, the National Geographic Channel, Time magazine, and CNN—also reported on Taiwan's NHI system.
Last year in its Expat Explorer Survey, the British bank HSBC reported that almost 70% of the respondents felt that Taiwan's NHI premiums were "inexpensive," while the quality of medical services was high. International expats thus gave Taiwan's NHI system their highest rating.
Overall, Taiwan's medical insurance system is considered to be one of the best in the world. Nevertheless, over the past 20 years, we've faced many challenges. Issues have included financial crises, lack of transparency in medical information, insufficient public participation in the program, and the wasting of medical resources.
The government has sought to address these issues while promoting reform and innovation by amending the National Health Insurance Act. Thus our "Second Generation NHI" initiative was launched on the first of January, 2013. Ten major second-generation reforms included promoting a referral system, expanding the system's fee base, enhancing care for the underprivileged, avoiding the improper use of medical services, and extending coverage to correctional institutions. Based on our vision of enhancing quality, caring for the underprivileged, maintaining system sustainability, and achieving or exceeding international benchmarks, we'll continue to work toward our ultimate goal—universal coverage with equal care.
Here, I'd like everyone to know that since we implemented our Second Generation NHI system, coverage has been extended to include all of the approximately 59,000 inmates in our jails and correctional institutions.
In terms of the right to health for the incarcerated, this is a significant development. As far as I know, among the major countries of the world, only France provides similar healthcare coverage. In other countries, coverage is reserved for inmates with special status, or healthcare services are provided on an individual basis through other means.
I myself feel particularly grateful for this reform because when I was the country's minister of justice, when the NHI was first launched in 1995, inmates were not included in the program. For a variety of reasons, I tried, but failed to change that. Now that the problems have all been taken care of, I'm very thankful to the Ministry of Health and Welfare for making this reform possible.
Here I'd like to note that in Taiwan over the last few years, there have been quite a few problems that we've found very difficult to resolve. Due to heavy workloads, long work hours, and lower-than-expected financial compensation, some physicians have decided to practice in other countries. This has led to a kind of "medical brain drain." As a result, the government implemented numerous reforms starting back in 2011, investing US$350 million to prevent the loss of medical personnel in five categories: internal medicine, surgery, pediatrics, obstetrics and gynecology, and emergency services. This issue, along with the NHI challenges I mentioned earlier, are in need of solutions.
I trust that the collective wisdom of the scholars and experts here today will help us address these problems, and come up with viable coping strategies. I also hope that you will give us recommendations for promoting NHI system reforms that will foster sustainable development, and provide a firm foundation for promoting a long-term care model for the future.
Finally, once again I'd like to welcome you, our friends from abroad, and thank our government agencies and civic groups for their tremendous support. Please accept my best wishes for a successful symposium.
Last but not least, if you are here, friends from abroad, for the first time, please take some time out of your very busy schedule to enjoy the very rich cultural life of my country. I would recommend that you visit the National Palace Museum and the night market. The Palace Museum will show you the art treasures of more than a dozen emperors over the last 3,500 years. The night market will give you an understanding of the daily life of the modern citizens of this country. Last, but not least, please do as much shopping as possible wherever you go to help our economy.
Thank you very much!