Taiwan's healthcare system is ranked as one of the top healthcare systems in the world. Admittedly, I don't have a lot of knowledge when it comes to the intricacies of healthcare and insurance. The process is a massive beast. But I've had my fair share of experiences in US hospitals and now a few in Taiwan, so I wanted to share what it's been like for me and provide some facts to inform readers who may be interested in learning more.
In 1995 Taiwan started a National Health Insurance (NHI) model, which was fundamentally based on the US system of Medicare. Taiwan however created a "medicare for all" universal healthcare system. This means coverage is offered by a government-run insurer, and spans outpatient visits, inpatient care, dental care, traditional Chinese medicine and more. As of 2014, 99% of citizens are covered by a national health insurance policy, and this also extends to foreigners with an ARC in Taiwan.
This program works through premiums paid by employers, employees and the government (typically under $50 USD per month for individual citizens). Employees don't have to worry about losing their insurance if they quit or are fired from their job, because they will still be on the national healthcare plan. The core belief is that there shouldn't be financial barriers to receiving medical care. Taiwanese citizens do not go bankrupt as a result of medical bills. Take a basic doctors visit for example. Most yearly check-ups are free. Regular office visits have a typical co-pay of $5 USD. Teeth cleanings are available every six months for $5 USD.
The process is also fairly easy. Each person has a healthcare card. This stores all of your health information. Without different insurance providers, citizen are free to choose any hospital or doctor they wish. Previous tests and records are stored and easily accessible via the healthcare card. Also, you don't need to visit a primary care provider to see a specialist. You can make an appointment, or walk-in and see a doctor the same day (You may have to wait a while, but the option is there).
Let me tell you about mine and a few of my friends' experiences.
I went to the doctor for unexplained swelling on my face after recently becoming unemployed. I walked into the hospital at 5:10 and was able to get an appointment with a specialist in the 6:00 time block. I killed an hour at a local cafe, then followed the clearly marked signs to the room with my appointment. Other patients were queued in a large waiting area. I stuck my health card into the computer by the door and my name popped up on the waiting list.
This was the longest that I had to wait to see a doctor, and it was maybe 30-45 minutes. When I saw the doctor, I discussed my symptoms, had a scope put in to check, had an x-ray and was prescribed antibiotics. I was able to pick up the antibiotics on the first floor and pay my bill at an automated pay station (using a receipt printed by the doctor). The total (for the appointment and antibiotics) was about $25 USD*. For reference in the US, the average cost of seeing an ENT is $357 and the low-end average of a weeks regimen of antibiotics is $350, for a whopping total of $700 (dependent on insurance policies).
My roommate was recently involved in a scooter accident. Since being unemployed, we have not filed to get back on the national health insurance plan, and as so, we are both uninsured. She suffered a laceration to her face as well as multiple contusions on her hip, knee and palm. She was taken to the ER, where she received a tetanus shot, six stitches on her forehead, as well as prescription painkillers and antibiotic ointments. The total time spent in the ER was under two hours. The total cost was $120 USD. In the US, it would have been nearly double for the same scenario.
The next week, she returned to the hospital to have her stitches removed. The entire visit took thirty minutes. Once the stitches were out and we had instructions on how best to prevent scarring, she paid $25 USD at an automated machine. In the US, for an uninsured patient this could cost around $200 USD.
Another one of my friends has a more serious illness. He spent a week in the hospital and had a litany of tests run. The total before insurance was $3,000 USD. After insurance, that came down to $430 USD. Then, because of the severity of his illness, he was given a Major Illness Card and the total was $100 USD. After a week in the hospital, he ended up only paying for the meals he ate. For comparison, the average hospital stay in the US costs $10,000 if you're uninsured, and even with insurance, can cost over a thousand dollars. Long stays can often bankrupt families, even with assistance from Medicare or Medicaid.
This is not to say that Taiwan's system is perfect. It does have drawbacks. While customer satisfaction stays around 80%, doctors and nurses are less happy with the system. There is a low doctor to patient ratio, which means that doctors have little time to spend with each individual patient. Not needing to see a primary care doctor for a referral, while nice for convenience, means there is no filter who sees a specialist first, this in turn means those with more severe cases won't be prioritized. From what I understand there are also concerns about the rate of expenditures outstripping the rate of growth.
That being said, every system has problems. And current estimates put Taiwan's healthcare system at least 20 years ahead of America's. While in a global pandemic, the need for healthcare is even more pressing. At the end of the day, my belief is that everyone should have access to affordable healthcare, no matter their income or pre-existing conditions. It should be a right, not a privilege, to receive care when you are sick or injured.
Taiwan doesn't have it all figured out, but it has created a decent blueprint that other countries could definitely benefit from implementing.
*When looking at the prices, the exchange rate and minimum wage in Taiwan should be taken into account. But basically in Taiwan Dollars, the cost of getting your teeth cleaned is equivalent to a meal or a fancy beverage.
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