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
Could Asia be on the verge of a new wave of nuclear proliferation? A look back at the early history of the North Atlantic Treaty Organization (NATO), which recently celebrated its 75th anniversary, illuminates some reasons for concern in the Indo-Pacific today. US Secretary of Defense Lloyd Austin recently described NATO as “the most powerful and successful alliance in history,” but the organization’s early years were not without challenges. At its inception, the signing of the North Atlantic Treaty marked a sea change in American strategic thinking. The United States had been intent on withdrawing from Europe in the years following
My wife and I spent the week in the interior of Taiwan where Shuyuan spent her childhood. In that town there is a street that functions as an open farmer’s market. Walk along that street, as Shuyuan did yesterday, and it is next to impossible to come home empty-handed. Some mangoes that looked vaguely like others we had seen around here ended up on our table. Shuyuan told how she had bought them from a little old farmer woman from the countryside who said the mangoes were from a very old tree she had on her property. The big surprise
The issue of China’s overcapacity has drawn greater global attention recently, with US Secretary of the Treasury Janet Yellen urging Beijing to address its excess production in key industries during her visit to China last week. Meanwhile in Brussels, European Commission President Ursula von der Leyen last week said that Europe must have a tough talk with China on its perceived overcapacity and unfair trade practices. The remarks by Yellen and Von der Leyen come as China’s economy is undergoing a painful transition. Beijing is trying to steer the world’s second-largest economy out of a COVID-19 slump, the property crisis and
As former president Ma Ying-jeou (馬英九) wrapped up his visit to the People’s Republic of China, he received his share of attention. Certainly, the trip must be seen within the full context of Ma’s life, that is, his eight-year presidency, the Sunflower movement and his failed Economic Cooperation Framework Agreement, as well as his eight years as Taipei mayor with its posturing, accusations of money laundering, and ups and downs. Through all that, basic questions stand out: “What drives Ma? What is his end game?” Having observed and commented on Ma for decades, it is all ironically reminiscent of former US president Harry