A conference on the national health insurance systems of Taiwan, Japan and South Korea was held in Taipei yesterday, with officials from the three nations sharing their experiences.
Taiwan, Japan and South Korea have similar health insurance systems in taking the form of social insurance and in having insurance premiums as the main source of the health fund, Department of Health Minister Chiu Wen-ta (邱文達) said.
Japan’s health insurance took shape in 1922, with the promulgation of the Health Insurance Act, and achieved universal coverage in 1961; South Korea’s health insurance system was launched in 1977, with all nationals covered by 1988.
Taiwan in 1995 integrated health insurance for civil servants and school staff, labor insurance and farmer’s insurance into a single National Health Insurance (NHI) system under the National Health Insurance Act (全民健康保險法), and incorporated those who were not covered by any social insurance (about 40 percent of the population at the time) into the system.
While Japan employs a multi-payer system, South Korea switched to a single-payer system from multi-payer in 2000, making it more like Taiwan’s NHI system, Chiu said, adding that despite their differences, the health insurance systems of all three countries have been facing financial difficulties.
Japan has responded by reforming pharmaceutical pricing, reimbursement, medical care for the elderly and the overall healthcare system. South Korea implemented the Special Act for Financial Stabilization from 2002 to 2006, which required the government to subsidize the NHI system through its general budget and a health surcharge on tobacco.
Taiwan’s NHI system, which is also supplemented by a surcharge on tobacco sales, has likewise carried out reforms to sustain the cash-strapped system, implementing a second-generation NHI system this year that imposes a 2 percent supplementary premium on non-payroll incomes an insured individual earns from an additional six sources, Bureau of NHI Deputy Director-General Tsai Lu (蔡魯) said.
Speakers from Japan and South Korea were asked their opinions on the surplus of hospital beds, a problem faced by all three countries, that has left healthcare providers exhausted and compromised the quality of care.
South Korean health official Jang Soo-mok said that his nation, like Taiwan, suffers from regional imbalances in the distribution of healthcare personnel and from personnel shortages and suggested offering better pay to attract more healthcare workers.
Japanese health insurance bureau official Kamada Shinryu said the number of beds does not have to be reduced, but “functional specialization” of beds should be employed, dividing the beds into the categories of highly acute, acute, sub-acute, etc, to streamline services.