Taiwan’s Single-Payer National Health Insurance

Milken Institute Review
Date: May 4, 2020
By: tsung-mei cheng

The idea of single-payer (government) health insurance — sometimes made more appealing to Americans by calling it Medicare for All and first proposed by Senator Bernie Sanders in 2017 — has gained considerable traction thanks in large part to the Democratic presidential primaries. A January Kaiser Family Foundation poll found that a narrow majority of Americans (56 percent) favor Medicare for All. But the candidates who want a single-payer system haven’t spelled out precisely what they mean. And most Americans, it is safe to say, have at best a fuzzy idea about what a true single-payer approach is and how it would work.

If Americans are somewhat familiar with any single-payer system, it’s the one in Canada. Here, I outline another single-payer system built almost from scratch more recently — and in a place that’s even more affluent than Canada: the island of Taiwan. Arguably the most startling aspect of Taiwan’s National Health Insurance (NHI) system is how they manage to get high-quality outcomes for a small fraction of what Americans pay — and how well they have managed the coronavirus pandemic. But I get ahead of myself.

The Origin Story

Before Taiwan chose to go the single-payer route, it had a crazy-quilt of 13 separate insurance schemes — Labor Insurance, Government Employees Insurance, Farmers Insurance and so on — which together covered just 59 percent of the population. And a disproportionate number among the remaining 41 percent were people who could least afford to go without: children, women, the elderly and disabled, and informal sector workers who had to pay out of pocket for needed care or forego it. Impoverishment from costly illnesses was commonplace, and health disparities were wide.

But when Taiwan decided that enough was enough, it plowed through a thicket of obstacles in relatively short order. After some seven and a half years of planning and 18 months of toiling through the legislative process, the government implemented its national insurance program in March 1995 — a full five years ahead of the original schedule. And once in place, it was implemented in startlingly little time: by the end of 1995, 90 percent of Taiwan’s then 21 million residents were enrolled.    [FULL  STORY]