In recent years, the National Health Insurance program (NHI) has faced mounting financial woes, leading to talk of increasing premiums and plans by the Bureau of National Health Insurance to exclude certain non-essential medication from NHI coverage.
In an exclusive interview with the Taipei Times, Fritz Britt, head of the Novartis Policy Office, Novartis AG, and Stefan Ziegler, Novartis Asia-Pacific regional head, talked about their thoughts on Taiwan's NHI system and how it compares with European health care systems.
Analyzing the cost distribution of the NHI, Britt said that he felt Taiwan was very "hospital heavy," meaning that the system favors the hospitals.
PHOTO COURTESY OF NOVARTIS
"Hospitals tend to be pretty expensive. In all the health systems I have seen, if you have [a scenario in which] you shift power to one of the players, then it's going to be more of a power game than a real balanced system. My experience of European systems is that you would rather have a balanced hospital and [clinic] system," Britt said.
According to Britt, 20 years ago in France the trend was the same, with hospitals tending to grow ever bigger. As a result, regulations were brought in to restrict hospitals to a certain growth rate. Britt said in comparison, hospitals in European countries such as France, Italy, Spain and Germany are far more closely controlled by the state, and subject to far more regulation.
"We don't want to jeopardize [clinics] because it's the [combination of hospitals and clinics] that makes treatment cost-efficient, and not [a health care system] in which the hospitals have a monopoly," Britt said.
PHOTO COURTESY OF NOVARTIS
Pointing to another "bucket" of costs, Britt talked about how Taiwan's NHI covers a broader range of services than other, more established systems in which services are more narrowly defined.
"Even in France or Italy -- the traditional total coverage systems -- they are now saying that [certain] treatments are privately paid for, that they are not covered by the reimbursement system. In the drug field, these are the over-the-counter drugs, the drugs for coughs colds, headaches -- the day-to-day types of drugs," Britt said. He went on to suggest that a good move for Taiwan would be to have some non-essential drugs being paid for "out of pocket."
"[Taking] these treatments out of the system means you free up money for the really costly interventions. This way you can really get rid of the financial pressure," Britt said.
Aside from regulatory changes, Britt and Zeigler emphasized the role which investment plays in cost containment.
"If you look around, the companies which survive are not only cutting costs, they are also investing in opportunities," Britt said.
By way of example, Britt pointed out that although advances in medical treatment and new types of drugs are expensive, they help to offset costs in other areas by reducing the length of hospital visits and keeping NHI members in the workforce.
"Innovation is probably the key to overall cost containment," he explained.
In Europe, where cost-cutting has been taken about as far as possible, efforts are being made to improve working methods and to use treatments and drugs that lead to shorter treatment loops.
Britt and Ziegler stressed that cost containment rather than cost-cutting was the goal, since with the increase in the number of diseases and the ageing population it was natural that the health system should grow -- preferably at a proportionate rate to the GDP.
According to Britt, in 2002 the percentage of health care expenditure as a percentage of GDP in Taiwan was 6 percent, which compares favourably to European countries where the figure is typically between 8-10 percent.
"The question is: 'What is the right proportion?' Most countries try to be between 8-10 percent of GDP," Britt said, explaining that where the proportion of health expenditure to GDP was higher than 10 percent, the health outcome wasn't necessarily visibly better.
However, in those countries where the figure is below 8 percent -- such as certain countries in Africa, Poland, or Hungary -- problems with the quality of health care result.
Ziegler explained that health expenditure as a percentage of GDP reflected things such as doctors per capita, hospital beds per capita and the time it takes to see a doctor.
"When you go below 8-10 percent of GDP it means you start to take infrastructure out of the system; you take a hospital out of the system, you take a [clinic] out of the system. When you decide [to do] this, you take that money and you put it somewhere else." Ziegler said, adding that such choices were conscious political decisions that affected the quality of health care.
Speaking about general recommendations for Taiwan's system, Britt said: "Taiwan needs a Taiwanese system. You can't copy another system -- there is no economically correct system."
Britt went on to explain that a system that worked in one country couldn't be guaranteed to work in another, since each has different starting points.
Britt referred to the Swiss health care system -- the only such system in Europe that is not bankrupt, according to Britt -- as an example. He said that a similar system couldn't be implemented elsewhere due to cultural differences and the fact that people would fight the changes.
Ziegler concluded by saying that what was important for Taiwan was that there should be a "vision" going forward.
"Say the vision 5-10 years down the road is a natural mix between private payments, private insurance systems, government insurance ? then you can work towards that."
AIR SUPPORT: The Ministry of National Defense thanked the US for the delivery, adding that it was an indicator of the White House’s commitment to the Taiwan Relations Act Deputy Minister of National Defense Po Horng-huei (柏鴻輝) and Representative to the US Alexander Yui on Friday attended a delivery ceremony for the first of Taiwan’s long-awaited 66 F-16C/D Block 70 jets at a Lockheed Martin Corp factory in Greenville, South Carolina. “We are so proud to be the global home of the F-16 and to support Taiwan’s air defense capabilities,” US Representative William Timmons wrote on X, alongside a photograph of Taiwanese and US officials at the event. The F-16C/D Block 70 jets Taiwan ordered have the same capabilities as aircraft that had been upgraded to F-16Vs. The batch of Lockheed Martin
GRIDLOCK: The National Fire Agency’s Special Search and Rescue team is on standby to travel to the countries to help out with the rescue effort A powerful earthquake rocked Myanmar and neighboring Thailand yesterday, killing at least three people in Bangkok and burying dozens when a high-rise building under construction collapsed. Footage shared on social media from Myanmar’s second-largest city showed widespread destruction, raising fears that many were trapped under the rubble or killed. The magnitude 7.7 earthquake, with an epicenter near Mandalay in Myanmar, struck at midday and was followed by a strong magnitude 6.4 aftershock. The extent of death, injury and destruction — especially in Myanmar, which is embroiled in a civil war and where information is tightly controlled at the best of times —
China's military today said it began joint army, navy and rocket force exercises around Taiwan to "serve as a stern warning and powerful deterrent against Taiwanese independence," calling President William Lai (賴清德) a "parasite." The exercises come after Lai called Beijing a "foreign hostile force" last month. More than 10 Chinese military ships approached close to Taiwan's 24 nautical mile (44.4km) contiguous zone this morning and Taiwan sent its own warships to respond, two senior Taiwanese officials said. Taiwan has not yet detected any live fire by the Chinese military so far, one of the officials said. The drills took place after US Secretary
THUGGISH BEHAVIOR: Encouraging people to report independence supporters is another intimidation tactic that threatens cross-strait peace, the state department said China setting up an online system for reporting “Taiwanese independence” advocates is an “irresponsible and reprehensible” act, a US government spokesperson said on Friday. “China’s call for private individuals to report on alleged ‘persecution or suppression’ by supposed ‘Taiwan independence henchmen and accomplices’ is irresponsible and reprehensible,” an unnamed US Department of State spokesperson told the Central News Agency in an e-mail. The move is part of Beijing’s “intimidation campaign” against Taiwan and its supporters, and is “threatening free speech around the world, destabilizing the Indo-Pacific region, and deliberately eroding the cross-strait status quo,” the spokesperson said. The Chinese Communist Party’s “threats