"Creating a New Chapter for Taiwan's Smart Healthcare Series 1: Discussing the Current State and Challenges of NHI Resources"

《Building a New Chapter for Smart Healthcare in Taiwan Series 1》

Current Status and Challenges of National Health Insurance Resources

In today's highly digitized and globalized era, the stability and innovation of healthcare systems are becoming even more critical. However, Taiwan's National Health Insurance (NHI) system has recently faced multiple difficulties and challenges, including concerns about resource allocation, the speed of drug reimbursement, increasing demand pressure from a growing elderly population, and discussions about intergenerational equity.

In this context, how to further develop and strengthen the NHI system is not only an economic issue but also a complex problem involving social justice, technological development, and demographic changes. Before discussing the future direction of the NHI system, we must first deeply understand its current dilemmas, background, and origins, so that we can propose effective countermeasures and recommendations for various challenges.

Subheading: Four Major Crises Emerge – What Problems Need to Be Solved?

Since its inception, Taiwan's NHI has been widely praised by the international community. However, over the years, it has faced severe tests in terms of resource input and allocation. It has undergone continuous review, reform, and evolution to cope with the ever-expanding demand for medical care. In response, Dr. Chung-Liang Shih, Director-General of the National Health Insurance Administration, Ministry of Health and Welfare, pointed out four major crises: lagging resource input, slow reimbursement for high-cost drugs, the advent of an aging society, and the strengthening of medical digitization. These not only reveal the specific medical problems of "finite resources; infinite demand" faced by Taiwan's NHI but are also common phenomena encountered by most developed countries worldwide.

When exploring the issue of resource input, we inevitably compare it with other countries. For example, according to World Health Organization (WHO) data, the United States' National Health Expenditure (NHE) accounts for 17% of its GDP (Gross Domestic Product), while Switzerland and Germany are 12% and 11.5%, respectively. In contrast, Taiwan's NHE accounts for only 7% of its GDP, which is a relatively low level globally. This inevitably raises concerns about whether such low input in Taiwan can adequately and sustainably support the fairness and accessibility of universal healthcare.

At the same time, the reimbursement of high-cost drugs also exposes the internal tension of the system. For example, in Sweden and Australia, the rapid approval and reimbursement of new drugs have shown excellent performance in increasing medical efficacy and improving patient treatment outcomes. Taiwan, on the other hand, seems relatively conservative. Although it has reimbursed drugs for major illnesses, including cancer, facing the development and application of medical technologies (such as cell or gene therapy) and new drugs, the annual drug cost growth rate of approximately 10% compared to only 4% growth in total NHI expenditure still poses immense pressure.

Taiwan, like all advanced countries worldwide, faces the severe problem of rapid population aging. As the proportion of the population aged 65 and over continues to rise, it may exceed 40% by 2040. This demographic change will undoubtedly have a significant impact on NHI resource allocation and financial pressure. This means that Taiwan, facing the challenges of an aging society, should re-evaluate medical resource allocation and system design with innovative thinking.

The tension between resource allocation and input, and societal needs and expectations, has brought the universal health insurance system to a crossroads. This also prompts us to engage in comprehensive and in-depth discussions and seek strategies and methods that can ensure the fair, sustainable, and efficient operation of the NHI system.

In fact, most countries face similar challenges in the management and allocation of health insurance resources, such as aging populations, rising medical costs, and how to provide quality medical services with limited resources. They have developed different and diverse strategies and approaches to address these issues.

1. UK optimizes healthcare resource allocation: The UK's National Health Service (NHS) employs a complex resource allocation system that attempts to ensure resources are distributed based on regional health needs and service costs. It uses data analysis to determine resource allocation ratios for different regions and establishes specialized funds to address health inequalities.

2. US adopts co-existence of private and government health insurance: The US healthcare system includes diverse payers, with both government-provided health insurance, such as Medicare and Medicaid, and private insurance companies. Government resources focus on supporting the elderly and vulnerable groups, while private insurance provides individuals with more choices and flexibility.

3. Germany implements a dual health insurance system: Germany's health insurance system covers public and private insurance. Most people obtain public health insurance through their employment, while private health insurance offers more personalized, value-added options. In addition, Germany also focuses on promoting preventive medicine to reduce future medical expenditures.

4. France mobilizes resources and invests in health technology: France's healthcare system is committed to ensuring efficient resource utilization by optimizing patient referral processes and promoting the use of electronic health records, thereby improving resource efficiency. It also actively invests in health technologies such as telemedicine and data analytics to reduce costs and improve service quality.

5. Singapore focuses on preventive healthcare: Singapore's healthcare system emphasizes shared responsibility between individuals and the government. Through systems like Medisave, everyone is required to save for their future medical expenses. The government also invests resources in preventive medicine and health education to reduce long-term medical burdens.

Each country exhibits different focuses and strategies in the management and allocation of health insurance resources. From investing in preventive medicine and utilizing technology to establishing resource allocation models, each strategy demonstrates how a country makes trade-offs and choices when faced with limited resources.

Compared to other countries, Taiwan has the advantages of datafication and widespread medical accessibility. By upgrading NHI digital AI technology, it can smoothly extend NHI from medical treatment to preventive care, from alliance services of medical institutions to at-home remote services, and develop precise capitation payments for individuals, thereby gradually reforming the system.