The Best Health Care System in the World?
During a visit to Taipei in 2015, I noticed that one of my ears was totally blocked. My friends took me to a pharmacy for some eardrops to remove the wax, but the pharmacist refused to sell them to me. “You need to go to an ear clinic,” he told me, and wrote down an address. The clinic was a few metro stops away near an MRT station on the Xindian line. By the time one of my friends filled out my health history form for me, I was ushered into a consultation room. The ENT specialist was in his mid-30s and had graduated with honors from Taiwan National University, Taiwan’s best. After fifteen minutes, my hearing was back to normal. The bill? US$14. And if I were Taiwanese, my co-payment would have been $3. During a more recent visit in 2024, I needed a consultation with a dermatologist, and a friend recommended one in Taipei who was Harvard-trained. I was able to arrange an appointment that evening. The bill had increased to US$22 for an uninsured person like me, while the co-pay for a Taiwanese had gone up to the equivalent of US$6.
Taiwanese enjoy one of the highest levels of health in the world. The life expectancy for Taiwan in 2023 averaged 81.04 years. By comparison, the life expectancy for China in 2023 was 77.47 years. Taiwan’s life expectancy increased 0.21 percent from 2022.
This is due in large part to Taiwan’s National Health Care System, introduced in 1995. It is consistently rated as one of the best in the world, and provides free and low-cost health care to every Taiwanese citizen and legal resident.
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Taiwan uses a single-payer healthcare system where one agency controls healthcare for everyone.
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All Taiwanese citizens must be enrolled in the NHI program, as well as others staying in Taiwan for more than six months. The National Health Insurance Administration (NHIA) covers everyone. Each healthcare consumer has an NHI-issued IC card that contains their medical records, so their medical history is readily available no matter where they seek health care.
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Even though Taiwan’s healthcare system is run by the government, doctors and hospitals operate privately. People are free to choose their health care provider, and only need to present their NHI card when they receive treatment. The provider then claims payment from the NHIA. Most patients are charged a small copayment depending on income. The normal copayment is NT$100, or approximately US$3.
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Taiwan’s National Health Insurance covers just about everything: inpatient and outpatient care (both primary and specialty care), prescription drugs (both Western and traditional Chinese), dental care (excluding orthodontics and prosthodontics), traditional Chinese medicine, kidney dialysis, maternity care and childbirth, physical rehabilitation, home care, mental health care and preventive care: adult health checkups, cancer screenings, baby and child health care checkups, and childhood immunizations through age 6.
NHI does not yet cover eyeglasses or visual acuity tests, nor does it pay for wheelchairs or hearing aids. When elderly Taiwanese need to see their doctor, the NHI even pays for transportation. But if you want a hair replacement, a tummy-tuck or other elective procedure, you’ll have to pay for it.
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Patient costs are based on income and financial need. Low-income workers, civil servants and others have their health care completely subsidized. However, the NHI has capped copayment amounts for everyone: prescription drug copays are capped at US$6.64 per prescription and visits to a specialist (such as my visit to the ENT clinic) cost about US$14.
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Healthcare administration costs in Taiwan are among the lowest of any developed country in the world: Taiwan spent only about 6 percent of its Gross Domestic Product (GDP) on its healthcare system in a recent year, a number that the journal Health Affairs called “remarkably stable” for years. By comparison, the United States spent 16.7 percent of its GDP on healthcare in 2022.
Unlike most other countries, the NHI system also covers essential dental procedures. Dental exams and dental many procedures (excluding cosmetic work and implants) also involve a $6 copay for Taiwanese citizens and legal residents. I have been receiving dental care in Taiwan for years without insurance, and find that the level of care is excellent and inexpensive.
My teeth have never been the greatest, and in 2021 I had a simple extraction done at a dentist’s office in a New York City suburb that cost $785. Another extraction at my dentist’s office in Taichung in early 2023 cost NT$700, or about US$22. This is one reason why Taiwan has become an important destination for “health tourists” who seek high level medical and dental care that costs a fraction of what they pay at home.
A December 12, 2024 article posted on Politico highlighted this problem. According to political scientist Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, “in 2022, over one in four Americans reported delaying or foregoing medical care, prescription drugs, mental health care, or dental care due to cost, with 17 percent of insulin users reporting in 2021 that they ration their insulin." The article also mentioned that a November 2023 Gallup poll found that just 31 percent of Americans trust the U.S. health care system. Dr. Yaver also found that 36 percent of 1,340 U.S. adults surveyed experienced at least one denial, and most of them had experienced this practice more than once.
At a time where many Americans are either lacking health insurance or are dealing with insurance companies that often delay or reject their doctor’s claims (known widely as “"deny," "defend" and "depose"), we should be taking a closer look at the Taiwanese healthcare system and follow its example as a healthcare system that actually works.
Sign outside a dentist office with the NHI logo.
Photo by Nathaniel Altman.
Notes:
Wu, Tai-yin et al., “An overview of the healthcare system in Taiwan,” London Journal of Primary Care 2010; 3:115–19.
“Six Facts About Healthcare in Taiwan, https://borgenproject.org/facts-about-healthcare-in-taiwan/
“Taiwan,” The World Factbook (cia.gov)
“Health Care Spending in the US and Taiwan,” https://www. healthaffairs.org/do/10.1377/hblog20190206.305164/full/
“Taiwan Life Expectancy,”https://www.macrotrends.net/countries/TWN/taiwan/life-expectancy
“Taiwan,” https://www.commonwealthfund.org/international-health-policy-center/countries/taiwan
Joshua Zeitz, "This Theory Could Explain the Reaction to the UnitedHealthcare Killer,"
Politico, December 10, 2024.
https://www.politico.com/news/magazine/2024/12/10/united-healthcare-killer-reaction-theory-00193513
