President Tsai Ing-wen (蔡英文) began her second term on Wednesday last week amid the COVID-19 pandemic, a major lesson from which nations worldwide are learning is the importance of a well-funded, robust and accessible health service.
Taiwanese have good reason to be proud of their excellent National Health Insurance (NHI) system, but the system is itself in poor health.
In December last year, the media reported that the total expenditure of the NHI had exceeded NT$700 billion (US$23.31 billion at the current exchange rate), with a deficit between NT$50 billion and NT$60 billion. At this rate, the system could go bankrupt next year, National Health Insurance Administration data showed.
Solutions include cutting costs or increasing revenue, or a combination of the two. The government has favored cutting costs, reluctant to increase premiums because it believed this to be politically unpopular.
At a meeting of the Legislative Yuan’s Social Welfare and Environmental Hygiene Committee on Monday, Democratic Progressive Party Legislator Kao Chia-yu (高嘉瑜) said that the nation’s high incidence of chronic disease is placing a huge burden on the healthcare system.
She said that NT$51.3 billion was spent last year on kidney dialysis and NT$23.1 billion on diabetes, and asked whether the government should consider levying an “obesity tax” on high-calorie and high-sugar foods.
At the Central Epidemic Command Center’s daily briefing the next day, Minister of Health and Welfare Chen Shih-chung (陳時中) said the government was looking at funding possibilities, adding that raising the NHI premium is not on its list of priorities.
Other nations, notably the UK and Mexico, have implemented a sugar tax to address obesity and obesity-related health issues, but studies so far have shown the tax’s effectiveness to be disappointing.
Detractors say such taxes have not led to a significant reduction in the consumption of sugary drinks, and when they have, consumers have turned to other high-calorie sources.
It is also a regressive tax, affecting lower-income far more than higher-income households, while increased costs incurred to companies are either passed on to the consumer or offset through job cuts.
Health Promotion Administration Director-General Wang Ying-wei (王英偉) in May last year said that the government had discussed a sugar tax, but concluded that the issue should be left to market forces, and that Taiwan’s love affair with takeout beverages would make a sugar tax difficult to regulate.
Even if the tax is not effective, the reasoning behind it is laudable. Ministry of Education data shows that about 30 percent of elementary and junior-high school students are obese. Obesity rates in Taiwan are Asia’s highest, second only to China.
In her inaugural address last week Tsai said that the government would target long-term healthcare and research on communicable diseases, such as coronaviruses, obesity has been linked to noncommunicable diseases such as diabetes, certain cancers and cardiovascular diseases. These place a huge burden on the healthcare system.
Governments have had two major priorities during the pandemic: Keep deaths to a minimum and avoid overwhelming national healthcare systems. Much has been made of “flattening the curve” and reducing the peak of patients needing care at any one time.
The same can be said for the imminent bankruptcy of the NHI system: The sooner it is addressed, the less painful averting the crisis will be. Officials in Taiwan should have learned this lesson by now.
If there ever was a time for the public to fully appreciate the healthcare system and accept an increase in premiums, it is now. If, as Chen said, raising the NHI premium is not on the government’s list of priorities right now, perhaps it should be.
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