Guaranteed health insurance fees also constitute an economic inducement for hospitals to expand, open up annexes off site or take advantage of economies of scale by entering into strategic alliances with other hospitals. Expansion means more clout in the market. In addition, hospitals compete with each other by offering treatments not provided for under the health insurance system, such as skin care, plastic surgery, weight loss, artificial insemination, post-natal care and well-equipped health check centers for the well-heeled.
In fact, studies have shown that the government only pays for 25 percent of medical care fees as part of the national health system, compared to 74 percent in the UK and 69 percent in Canada. In other words, health insurance in Taiwan has actually encouraged privatization in the medical care industry and the principle of survival of the fittest has also come into play, leading to significant reductions in the government’s financial burden.
Of course, the provision of health insurance doesn’t come for free and politics sometimes gets in the way. The Taipei City Government, for example, has held back from paying what it owes, and given the black cloud looming over the legislature of late over the so-called “second generation” health insurance plans, it seems the system falls somewhat short of providing universal coverage. It is certainly not the social welfare system that so many people had hoped for or might wish to celebrate. There is still some way to go.
Since President Ma Ying-jeou (馬英九) came into office, we have seen a string of measures to cut taxes and Ma is now contemplating increasing the amount of borrowing the government at all levels can take on. This is debt that will be passed on to our children and grandchildren. Politicians don’t seem to have considered the possibility of financing health insurance with income tax takings or tax reform, they would prefer to have a bloated tax collection agency, the BNHI. The people who are going to suffer from this are single people and hard-working nine-to-fivers.
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
TRANSLATED BY PAUL COOPER
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