Taiwan: Achievements and Challenges in a Single-Payer System

Abstract Taiwan’s single-payer national health insurance system, adopted in 1995, is often celebrated as a model for other healthcare systems and an example of what a single-payer approach can achieve. Taiwan has achieved a system of universal coverage that is equitable and costs less than most healthcare systems in wealthy countries. This chapter provides a brief history of the Taiwanese healthcare system and identifies its achievements and shortcomings. Overall, the implementation of national health insurance has dramatically increased access to the healthcare system and has reduced inequalities in the use of both ambulatory and hospital care. Some studies have found inequities in the use of specialty care and surgical services, but these disparities are smaller than those that exist in many advanced healthcare systems. Poorer access to healthcare among indigenous populations and those who live in mountainous areas or in outlying islands remains a concern. Two of the biggest challenges faced by the system are the adequacy of its payments to clinicians and the size of the clinician workforce. Taiwan has kept healthcare spending low, but critics argue that its fees to healthcare professionals may be too low, particularly in light of increasing demand for healthcare services as the population ages.