Taiwan’s healthcare system is well deserving of praise, but it is far from perfect. People are still forced to pay out of pocket for many lifesaving treatments, even for the nation’s most fatal disease.
Cancer has been the leading cause of death in Taiwan for the past 40 years, with the number of diagnoses rising every year. According to the latest data available, 28 percent of people who died in 2021 had cancer, or 51,656 out of 184,172 people. The most deadly type was lung cancer, which claimed 10,040 lives in 2021 and is notoriously difficult to detect early, followed by colorectal cancer with 7,970 deaths.
Cancer treatment exerts the greatest pressure on the National Health Insurance (NHI) system. NT$121.2 billion (US$4 billion) was spent on cancer treatment in 2020, the equivalent of NT$1 out of every NT$5.5, NHI Administration data showed. Of that amount, NT$36 billion was spent on medication, the most for any condition. With cases rising every year, costs are expected to stay high.
Constant advances in oncology also make cancers particularly expensive to treat. Better treatments are coming out all the time, with the NHI approving 55 new cancer drugs from 2018 to 2020. Yet lacking a fast-track review mechanism, the NHI does not cover many of the newest and best treatments, forcing cancer patients to either pay out of pocket or settle for a less effective but affordable option.
Chou Yiing-jenq (周穎政) of the National Yang Ming Chiao Tung University’s Institute of Public Health recently highlighted the issue, noting that the cost of new lifesaving drugs has “become a nightmare” for patients and their families.
According to a survey conducted by a cancer support organization, nearly three-quarters of cancer patients had to personally pay for at least part of their treatment, with one-quarter of those with late-stage cancer facing bills of more than NT$1 million.
Depending on what is covered by the NHI, some people, due to personal constraints, have to delay treatment until their cancer reaches a life-threatening stage, when it might be “too little too late.” A 2018 study found that for lung cancer, the mean monthly cost for patients form a U-curve, with costs the highest in the early and late stages. They were US$4,683, US$2,023 and US$6,792 from early to late stages. Lung cancer in particular is critical to treat early, making the high cost of early treatment a hard pill to swallow.
With the number of cancer diagnoses on the rise, the fatality rate and financial burden that comes with treatment is a palpable concern. The government has recognized the problem and consistently puts forward incremental solutions. Some of the most successful have been subsidized screening programs for colorectal, oral, cervical, breast and lung cancers, helping to catch conditions early while they are still easily treatable. Still, Taiwan has some of the worst survival rates for certain cancers among high-income countries.
Experts have called for the establishment of a dedicated national cancer treatment fund, especially for highly cost-effective and innovative treatments such as targeted therapy and immunotherapy. The NHI Administration is also examining genetic testing to better ascertain the right targeted drugs, reducing the need to try many different costly treatments before finding the right one.
Forcing anyone to choose between their life and their family’s financial ruin is a human rights travesty that no one should endure. As long as the problem persists, the government should do everything in its power to alleviate it.
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