Rethinking health reform
One of US President Donald Trump’s very first acts in office was to sign an executive order as a prelude to changing Obamacare. Hopefully, this will spur Taiwanese into seriously thinking about reforming our National Health Insurance (NHI) system.
Taiwan’s, like many other systems, is aimed primarily at offering patients comprehensive coverage along with minimal copayments.
The reason Taiwan’s national healthcare system is in dire financial straits is simply that its generously broad medical coverage, which often includes even the most routine medical services, flies in the face of what national medical insurance is supposed to achieve. This would be to provide basic support in the case of unpredictable medical bills, which may cause serious financial burdens for patients and their families.
Most formal definitions of insurance pricing in some way refer to the negative effects of random events.
In this spirit, going to the doctor for a cold once or twice a year should certainly not be covered, as it is neither a financial burden for most patients nor is it unpredictable. After all, there are two flu seasons annually and patients can save up for these foreseeable visits.
In the rare cases in which a cold turns into pneumonia requiring hospitalization, coverage might well be appropriate.
Under the current system a tremendous amount of paperwork arises primarily because of the wide range of coverage provided by the NHI.
Every single visit, without exception, that the insurance covers adds to the burden of the whole system, due mostly to both the record keeping needed for the medical provider to be reimbursed and the concomitant efforts required to detect fraud.
Taiwan’s current system’s virtually blanket coverage of fairly routine visits also discourages good healthcare practice on the part of patients.
I know many Taiwanese who engage in quite risky sports without a thought for the costs resulting from a potential injury.
In addition to this moral hazard, due to the fact that in Taiwan the balance of power between employers and employees is decidedly in favour of the former, the medical system is subsidizing employers’ harsh treatment of employees with the tacit approval of the government. Taiwanese employees’ exceptionally easy access to medical care, especially late in the evenings after working hours, robs “responsible” employees of any excuse for taking time off for a doctor’s visit. They feel obliged to go to a physician and get a prescription for potent drugs.
Thus supervisors feel under no obligation to give workers any time off to recuperate, which would seem to be the best medical practice. Inevitably the generous medical benefits are counterbalanced by inadequate reimbursements to physicians for their services to achieve at least a semblance of budgetary responsibility.
Employees would be far more likely to insist on time off if copayments were more in line with the actual services rendered.
Medical insurance for the vast majority of Taiwanese needs to be completely separated from any welfare benefits to low-income patients who cannot afford even basic medical services.
Bernard M.
Taipei
Benefit discrimination
Among foreigners with a resident’s certificate living and working in Taiwan for many years, paying taxes, many of them with a Taiwanese spouse, few choose to stay in Taiwan when they retire.
It appears that they can not have the same benefits of retired Taiwanese. For example: 50 percent discounts on [public] transportation. Until few months ago, elderly foreigners could get a 50 percent discount on high-speed rail tickets and sit in carriage No. 7 with facilities for people in a wheelchair. Not any more.
The same benefits of retired Taiwanese are now given to foreigners whom contributed in some way to the country, like missionaries and priests.
So why do Taiwanese whom did not contribute to the country in the way mentioned above get the benefits after they retire?
Is it not discrimination?
Bernard Bordenave
Taipei
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