"Creating a New Chapter for Taiwan's Smart Healthcare Series 2: How to Solve Generational Inequity?"
Building a New Chapter for Smart Healthcare in Taiwan Series 2
How to Address Intergenerational Inequity?
Following the first article that revealed the current state and challenges of Taiwan's National Health Insurance (NHI) system resources, and introduced the diverse strategies and approaches adopted by countries like the UK and US to address similar challenges, this article will explore the current situation of Taiwan's NHI system, starting from the distribution of insurance burdens among the insured and the 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 is a stark generational divide between the decreasing working population and the increasing dependent population – young and middle-aged individuals actively paying NHI premiums versus the elderly who heavily rely on medical resources. As the current young and middle-aged population ages, they will face an inequity of even scarcer medical resources, creating a social and economic contradiction.
Subtitle: Uneven Resource Distribution May Lead to Social Dissatisfaction and Division
This intergenerational inequity is not unique to Taiwan; in fact, all aging countries face similar challenges. The intergenerational conflict lies in the possibility that younger generations may feel that their contributions and burdens, under an unchanged system, may not yield equivalent returns in the future.
In some European countries, such as Italy and Greece, young people face extremely high unemployment rates, and at the same time, they contribute financially to massive social insurance systems but face an uncertain future return. Similarly, Japan faces the dual challenges of severe aging and economic decline, forcing the government to raise consumption taxes to cover the financial deficits of its social security system, which also increases the economic burden on younger generations.
Returning to Taiwan, we see a similar situation. 25% of the population (mainly the elderly) accounts for 80% of NHI expenditures; 75% of the population (mostly non-elderly), despite being the primary 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, but relatively, the significant healthcare needs of younger generations, such as fertility (pre- and post-natal care) and maternal and child preventive healthcare, are overlooked. The imbalance in intergenerational distribution of NHI resources may create social dissatisfaction and division.
At the same time, how to ensure that the current main burden-bearing groups of NHI receive necessary medical resources in their old age and alleviate intergenerational inequity will be a major challenge. To promote intergenerational fairness, it is necessary to rethink and adjust the distribution model of healthcare burdens and resources, and to promptly strengthen support for the health maintenance of young families and children. This requires utilizing Taiwan's rich existing health databases to analyze and estimate the health and medical needs of each generation, 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 imbalance in intergenerational health and medical supply.
Various strategies and approaches have been adopted by different governments to address the challenge of intergenerational equity under their healthcare systems. We have compiled some of the methods and schemes adopted by the following countries in this regard:
Subtitle: Italy Implements Youth Employment Programs
Italian youth face extremely high unemployment rates, so the government has formulated various youth employment promotion programs, including providing 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.
Subtitle: Japan Raises Consumption Tax to Fund Medical Expenses
In response to the growing elderly population and medical expenses, 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.
Subtitle: Germany Invests in Intergenerational Healthcare
Germany invests resources in preventive care and primary healthcare, especially for young families and children. This is reflected in the balanced consideration of different age groups within the healthcare system, and it is also an investment in the next generation, ensuring the continuous stability of society.
Subtitle: Sweden Adopts a Flexible Retirement System
Sweden allows and encourages the elderly to continue working after a certain age. This not only reduces the burden on younger generations but also allows the elderly to continue contributing to society when they are able and willing to work.
Subtitle: Singapore Establishes Individual Savings Account System
Singapore's healthcare system emphasizes individual responsibility, with each person 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 multi-faceted thinking and application. When facing similar intergenerational issues, Taiwan may be able to refer to these experiences, combine them with local actual conditions, and find a suitable path. For example, by promoting employment for younger generations, 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 provide new possibilities for solving the problem.