Minister of Health and Welfare Hsueh Jui-yuan (薛瑞元) on Wednesday last week said that international students, including students from China, would be eligible to join the National Health Insurance (NHI) system from the academic year starting in September next year. The policy would promote equality of health rights among international students, but also pose a challenge to the NHI’s financial stability.
Currently, international students with valid residence certificates who have lived in Taiwan for six months are eligible to join the NHI system at a monthly premium of NT$826 (US$25.55). However, Chinese students are excluded. They can only sign up for basic student insurance and buy private health insurance. Hsueh said that the ministry would amend the National Health Insurance Act (全民健康保險法) to waive the six-month residency requirement and allow Chinese students to join the NHI.
The reform comes after Taiwan’s diplomatic ally Paraguay expressed concern over the health rights of its students studying in Taiwan. Vice President William Lai (賴清德) endorsed expanding the health rights of international students and suggested that Chinese students be included in the NHI.
Lawmakers should support the policy, which would help efforts to recruit international students. It is also crucial to establishing a more complete epidemic prevention network, especially after the COVID-19 pandemic.
In 2016, when the number of Chinese students in Taiwan reached a high of 41,975, President Tsai Ing-wen’s (蔡英文) administration approved an amendment to extend NHI coverage to Chinese students to ensure international students received equal health treatment. However, the amendment was shelved due to disagreements over the premiums for international students, with some international students protesting against paying the full NHI premium. Meanwhile, many Taiwanese said that foreign students should pay full premiums without receiving a government subsidy.
The issue is returning to the spotlight, in spite of the Ministry of Health and Welfare’s statements that premiums for international students had not yet been determined. Some lawmakers and pundits have suggested that insured international students should pay the full premium of NT$1,377 per month, just like other residents from overseas who qualify for the NHI.
The state-run health insurance system has faced financial problems in the past decade, with its shortfall rising to NT$67 billion in 2020.
The government has to increase its subsidy for the system to NT$44 billion, including funding through pandemic prevention budget, also to raise premium and supplemental premiums to collect NT$65 billion, which barely maintains the NHI’s financial balance.
Facing growing debts due to a decrease in premium income from low birthrates and yearly 3 to 4 percent increases of insurance benefit expenditures in accordance with an aging population, the NHI needs an actuarial review. It must adjust premiums for international students if expanding coverage to Chinese students, even with the number of Chinese students declining to about 2,000 this year due to Beijing’s ban on its students studying in Taiwan.
To be a country recognized for human rights, Taiwan should ensure that all students have equal access to national health insurance. However, it is a more crucial task to protect the financial stability and sustainability of the NHI, which is critical to the welfare of all Taiwanese.
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