Healthcare for all — A critical review of Taiwan's national health insurance system through a social institution lens
This paper offers a comprehensive and ethically-grounded framework for evaluating and reforming national health insurance systems. Its conclusions are particularly relevant for countries with universal healthcare systems facing challenges of sustainability, equity, and public trust. The emphasis on social solidarity and public engagement also speaks to broader global discussions about the role of healthcare in society and democratic governance of public institutions.
College of Health researcher(s)
Abstract
Since its 1995 implementation, Taiwan's National Health Insurance (NHI) system has made significant progress while also facing challenges. It receives both acclaim and critique in international comparisons especially in the quality and outcomes of healthcare. The NHI system persistently enjoys a very high population satisfaction rate: often70% −80%, and above 90% since 2020. Yet there is increasing dissatisfaction from providers, especially around low nurses' salaries, physicians' long working hours, and the slow inclusion of new pharmaceuticals among its covered drugs. During the 2023–2024 Presidential election campaign, NHI system reform was also a contentious agenda among candidates.
As debates on the future of Taiwan's NHI system continue, a resurfacing issue is the expansion of the private financing of Taiwan's healthcare system. Options under consideration include opening stand-alone private health insurance, expanding supplemental private health insurance, or increasing the private payment options. The same issue was hotly debated only three years after the implementation of the NHI system, with at least five legislative proposals in 1999.
Our motivation in this review is to critically examine these debates and consider the future of Taiwan's NHI system. We intend to add a new voice to this debate providing a different critical perspective by considering the NHI through the lens of social institutions. We will begin by introducing the ethical and normative assumptions of our analytical framework, followed by a discussion of the ecology of Taiwan's NHI system and its strengths, weaknesses, and future challenges. We conclude with proposals for how the system may be strengthened to achieve its goals.