Taiwan: ‘National Health Insurance’ System in Crisis

Taiwan's National Health Insurance is often used as a ‘model for reform’ in countries such as the United States where health care depends on a private insurance system. A recent article written by Princeton professor Uwe Reinhardt in the New York Times blog also praises the efficiency of the Taiwanese system.

Yet, the inconvenient truth unknown to the outside world is that such efficiency is built upon exploitation of medical staff.

Professor Reinhardt's article was written after the 2012 Europe-Taiwan Health Dialogue held in Taipei in July. He was impressed by a presentation by the Director of the Medical Informatics Center at the Department of Health in Taiwan, who talked about the efficiency of the national health care data system which monitors infectious disease.

Even though Reinhardt acknowledged the fact that Taiwan's health care is underfunded with only 6.7 percent of its gross domestic product going to health care, compared with close to 18 percent being spent in the United States, he is unaware that this low budget is at the expense of medical staff in Taiwan.

The profile picture of TMAL in Facebook

The Taiwan Medical Alliance for Labour Justice and Patient Safety (TMAL) [zh] posted a table comparing the cost of some common medical procedures on their Facebook Page. It shows that in the U.S. 25-350 times higher is charged than what is charged in Taiwan for the same procedure. The Alliance explained:


National Health Insurance is way too cheap. The only way it can survive is oppressing the medical staff and reducing the price of medication to an extreme.

Medical staff protest against the phenomena of death from overwork. Photo from TAML's Facebook Photo Album.

TMAL further elaborated [zh] by quoting a comment made by Professor Jung-Der Wang from the Department of Public Health at the National Cheng Kung University on their Facebook page:


Medical expenses are reduced partially by sacrificing the salary and quality of life of medical staff. Because National Health Insurance reduces the payment for medical care, hospitals do not earn enough money. Therefore, the salary of medical personnel is low, while their working hours are very long. This is why we call these hospitals sweatshops and why we see some death from overwork cases in this demographic.

In addition to the high risk of sickness due to overwork, medical doctors in Taiwan face high volumes of medical malpractice lawsuits. Decode-medicine [zh], an online journal on Taiwan medical profession, highlighted the astonishing statistic concerning the prosecution and conviction rate of doctors in Taiwan:


Since 2000, there has been more than one lawsuit for medical malpractice per day in Taiwan…80% of them are criminal suits. On average, one medical doctor is prosecuted in a criminal lawsuit every 10.5 days. On average, one medical doctor is declared as guilty in these criminal suits every 38.8 days. The “conviction rate” of medical doctors in Taiwan is 25.6%, the highest in the world.

The increasing number of lawsuits against medical doctors, along with long working hour and low salary, discourages young physicians from joining the five major medical departments [zh], including Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, and Emergency.

TMAL summarized [zh] the crisis of the National Health Insurance system in Taiwan:


National Health Insurance in Taiwan is run like a tall building without a proper foundation. When we made the plan for  national health insurance, we did not build a good foundation for it. (We did not guarantee reasonable working hours, we did not consider the risk of medical procedures, and we did not plan for an insurance system related to medical disputes.) This building has been built taller and taller, and this tall building is now shaking and falling apart!


  • Michael

    I understand the point being made and think it is quite possibly true that medical staff are being overworked.

    However I don’t thing the article makes the case clearly enough by referencing appropriate comparisons.

    The world knows that USA and maybe Japan have the most inflated medical costs. If comparing National Health Insurance costs in Taiwan, it should be compared to other effective national insurance schemes. The USA is a statistic outlier and their system is also regarded as broken because of excessive medical overcharging compared to almost any other country.

    The USA is struggling to control this cost and medical insurance costs are so crippling that many cannot afford any insurance at all.

    It would be more appropriate to compare with other countries who have similar systems. Maybe compare with Australia or UK or the Scandinavian or European countries.

    This will reduce the comparison percentage significantly. Here is a full list from the OECD in 2008.

    United States ( 16.0)
    OCED average ( 9.0)Australia ( 8.5)
    Austria ( 10.5)
    Belgium ( 10.2)
    Canada ( 10.4)
    Chile ( 6.9)
    Czech Republic ( 7.1)
    Denmark ( 9.7)
    Finland ( 8.4)
    France ( 11.2)
    Germany ( 10.5)
    Greece ( 9.7)
    Hungary ( 7.3)
    Iceland ( 9.1)
    Ireland ( 8.7)
    Italy ( 9.1)
    Japan ( 8.1)
    Korea ( 6.5)
    Luxembourg ( 7.2)
    Mexico ( 5.9)
    Netherlands ( 9.9)
    New Zealand ( 9.8)
    Norway ( 8.5)
    Poland ( 7.0)
    Portugal ( 9.9)
    Slovak Republic ( 7.8)
    Spain ( 9.0)
    Sweden ( 9.4)
    Switzerland ( 10.7)
    Turkey ( 6.0)
    United Kingdom ( 8.7)

    Second problem is the manipulation of the legal law suits against doctors. The claim is made that one doctor is successfully prosecuted every 38 days.
    That is less than 10 a year. Not a significant number compared to the full number of doctors in Taiwan.

    If the aim of the article is to support medical staff, it fails. Because it doesn’t use sensible comparisons. To help you need to find real data that places the USA in a true global context.

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