"Crafting a New Chapter for Smart Healthcare in Taiwan Series 2: How to Resolve Generational Inequity?"
Chapter 2 of "Building a New Chapter for Taiwan's Smart Healthcare"
How to Address Intergenerational Inequity?
After the first chapter revealed the current state and challenges of resources within Taiwan's National Health Insurance (NHI) system, and introduced diverse strategies and approaches adopted by countries like the UK and US to address similar challenges, this chapter will explore the current situation of Taiwan's NHI system from the perspective of the insured's premium burden distribution and intergenerational equity in accessing medical resources, and propose valuable lessons from other countries.
When discussing the current state of Taiwan's NHI system, the issue of intergenerational equity is becoming increasingly prominent. In a rapidly aging society with a declining birthrate, there are two distinct generations: the younger and middle-aged individuals actively contributing to NHI premiums, and the elderly who are highly reliant on medical resources. The current younger and middle-aged generation, when they age, will face the inequity of even more constrained medical resources, creating a social and economic contradiction.
Subheading: Uneven Distribution of Resources Could Lead to Social Dissatisfaction and Division
This intergenerational inequity is not exclusive to Taiwan; in fact, all aging countries face similar challenges. The conflict between generations arises because the younger generation may feel that their contributions and burdens, under an unchanging system, might not yield equivalent returns in the future.
In some European countries, such as Italy and Greece, the younger generation faces extremely high unemployment rates, while simultaneously contributing to a massive social insurance system, yet they face an uncertain future regarding potential returns. Similarly, Japan also faces the dual challenge of severe aging and economic decline, forcing the government to increase consumption tax to compensate for the fiscal deficit of the social security system, which also exacerbates the economic burden on the younger generation.
Returning to Taiwan, we also see a similar situation. 25% of the population (mainly the elderly) accounts for 80% of NHI expenses; 75% of the population (mostly non-elderly), despite being major contributors to NHI premiums, utilize far fewer medical resources than the elderly. Most NHI funds are used for the treatment of multiple chronic diseases and critical illnesses in the elderly, while the significant medical and health expenditure needs of the younger generation, such as fertility (pre- and post-natal care) and maternal and child preventive healthcare, are relatively neglected. The imbalance in the intergenerational distribution of NHI resources could create social dissatisfaction and division.
At the same time, ensuring that the primary groups currently bearing the NHI burden receive necessary medical resources in their old age and alleviating intergenerational inequity will be a major challenge. To promote intergenerational fairness, it is necessary to reconsider and adjust the medical expense burden and resource allocation model, and to timely strengthen support for the health maintenance of young families and mothers and children. This requires utilizing Taiwan's rich existing health database to analyze and estimate the health and medical needs of each generation of citizens, and to comprehensively adjust national healthcare policies, including the allocation of resources for NHI, medical care, epidemic prevention, national health, long-term care, and social welfare, to address the inequity in intergenerational health and medical supply.
Various government strategies and approaches have been implemented to address the challenges of intergenerational equity under the NHI system. We have compiled some methods and schemes adopted by the following countries in this regard:
Subheading: Italy Implements Youth Employment Programs
Young people in Italy face extremely high unemployment rates, so the government has formulated several youth employment promotion programs, including offering tax incentives to employers and encouraging them to hire young employees. This not only improves the economic situation of the younger generation but also helps stabilize their contributions to the healthcare system.
Subheading: Japan Raises Consumption Tax to Fund Medical Expenses
To cope with the growing elderly population and medical expenditures, Japan has raised its consumption tax to fund its social security system. The purpose of this approach is to spread the cost of social security so that it is not solely borne by the labor market.
Subheading: Germany Invests in Intergenerational Healthcare
Germany allocates resources to preventive healthcare and primary care, especially for young families and children. This is reflected in the balanced consideration of different age groups within the NHI system, and it is also an investment in the next generation, ensuring the continuous stability of society.
Subheading: Sweden Adopts a Flexible Retirement System
Sweden allows and encourages older people to continue working beyond a certain age. This not only reduces the burden on the younger generation but also allows older people to continue contributing to society when they are able and willing to work.
Subheading: Singapore Establishes Individual Savings Account System
Singapore's healthcare system emphasizes individual responsibility, with everyone having a savings account for medical expenses. This not only reduces the burden on the government and society but also ensures that everyone can receive the necessary medical services when needed.
The response strategies of different countries demonstrate diverse perspectives and applications. Taiwan, when facing similar intergenerational issues, might be able to draw on these experiences, combine them with local realities, and find a suitable path. For example, by promoting employment among the younger generation, strengthening support for families, and reallocating medical resources, intergenerational balance and fairness can be achieved. At the same time, introducing new technologies and data analysis methods to further optimize resource allocation and utilization may also offer new possibilities for solving the problem.