For Some Foreign Nationals, Taiwan is Unlivable

Michael Boyden and his family members. Boyden has lived in Taiwan since 1989 but can still not access disability benefits.

Foreign residents in Taiwan are facing discrimination and limited access to disability benefits, sparking a campaign by activists and non-profit organizations for equal rights and recognition.

In July, publicly funded media service TaiwanPlus aired a four-minute news feature that moved viewers to tears, judging by reactions on Twitter (now X). The feature, headlined “Foreigners in Taiwan Fight for Equal Disability Rights,” focuses on Michael Boyden, a long-time British business consultant in Taiwan who was diagnosed four years ago with Atypical Parkinsonism. This disorder attacks the brain and nervous system and progresses faster than Parkinson’s disease.  

The footage shows Boyden lying in bed, unable to move or speak, while his Taiwanese wife Katy Ho cares for him. She supports his body with cushions, prepares his food for delivery through a syringe, gently maneuvers him into a wheelchair, and kisses him lightly on his cheek. Holding back tears, Ho describes how although Boyden has lived in Taiwan since 1989, he is ineligible to apply for state disability benefits because he is not Taiwanese. The lack of access to medical visits, subsidized equipment, and respite care has put immense pressure on the family. 

Boyden’s case is just one of many raised by activists seeking to open up disability rights to foreign residents in Taiwan. Their call comes at a time when Taiwan has enthusiastically outlined its ambitions to attract 400,000 foreign workers over the next decade to ease its rapidly shrinking workforce.  

But discriminatory policies, such as denying access to disability services and other restrictions on some healthcare protocols, will send mixed messages to foreigners looking to relocate here. For example, daughters of foreign residents are ineligible for free shots of the Human Papillomavirus (HPV) vaccine offered to junior high school-aged girls in Taiwan by the Health Promotion Administration of the Ministry of Health and Welfare (MOHW).  

Crossroads, a non-profit organization focused on promoting Taiwan’s internationalization, is one of those leading the call for equal disability rights.  

“We were quite shocked to learn how a country that supposedly values human rights and is a leader in democracy would have this glaring hole in its treatment for immigrants, especially people who have already been here for 10, 20 years paying their taxes,” says Crossroads Secretary-General David Chang.  

The problem is that to access disability services in Taiwan, you need a disability certificate. “It’s your pass, it’s your identity, it’s your proof that you’re disabled,” Chang says. “Without this proof, you’re unable to access services officially – even though you may be in a wheelchair, obviously visually impaired, you just won’t be recognized by the system as being disabled.” 

Disability certificates are issued by the Household Registration Bureau and therefore open only to Taiwanese nationals, with one exception. Around two decades ago, Japanese residents protested the unfairness of denying them disability rights when Taiwanese residents could access free disability services in Japan. Now Japanese living with disabilities can obtain a disability certificate by going to their district’s household registration office and presenting the Executive Precedent stating the eligibility of Japanese nationals, notes Tim Chen, Crossroads’ deputy chairperson. 

Businesswoman Carrie Kellenberger is actively campaigning for equal access to care in Taiwan.

Taiwan could offer the same rights to all foreigners – there is no need to pass any new law or reform an existing one, Chen says. “There’s nothing in the law about including or excluding foreigners. It’s at the discretion of the Ministry of Health and Welfare.” 

Crossroads launched a campaign this March advocating for equal access to disability benefits for foreign residents. Since then,  MOHW has started to consider offering foreign residents access to disability status if Taiwanese nationals can obtain such status in their countries. Chang says it was easy to make the decision for Japanese residents because, like Taiwan, Japan uses a disability certification system, making reciprocity a straightforward issue.  

But for countries whose systems are quite different from Taiwan’s, defining reciprocity is more complicated. Indeed, MOHW’s insistence on obtaining detailed information on disability services open to Taiwanese in scores of countries has stalled progress on finding a solution, Chang says. Still, Crossroads successfully lobbied legislators to include an attachment to a new social welfare law passed in May, giving the ministry six months to figure out the reciprocity question.  

“Amendments to the Act for the Recruitment and Employment of Foreign Professionals have also been proposed that will be discussed in the upcoming fall session of the legislature,” says Chang. If passed, the amendments will make permanent residents who have resided in Taiwan for at least 10 years eligible to apply for disability status.  

Struggling for recognition  

Canadian businesswoman and disability rights campaigner Carrie Kellenberger, who teamed up with Crossroads for the disability benefits access campaign, has been living in Taiwan with her husband since 2006. For decades she has endured crippling pain and is often confined to a wheelchair because of several conditions, including inflammatory spinal arthritis and fibromyalgia, a chronic disorder that causes pain and fatigue. Her husband is her full-time caregiver. 

Obtaining a disability certificate would “change our lives,” Kellenberger says. Firstly, it would make her eligible for a disabled parking pass. Without the pass, Kellenberger’s hospital visits include the added stress of getting out of the car and into her wheelchair at the busy entrance before waiting for her husband to park. 

A certificate would also grant her access to subsidized medical equipment, such as wheelchairs. “It is very expensive to be chronically ill and disabled in any country you live in, but Taiwan is especially expensive because I have to pay for everything… mobility devices, pain relievers, parking prices because of long hours at the hospital, special taxis that start at NT$400… and that is just the tip of the iceberg,” says Kellenberger. 

But it’s not just about the money. Foreigners with disabilities describe how this discrimination makes them feel ignored or invisible, even though they have been here for years, paying taxes and contributing to Taiwanese society. 

South African Andrew Klerck, founder of Taiwan Impact Entrepreneurs, finds the discrimination degrading. “It’s just reminding you of your second-class citizenship,” says Klerck, who has been blind for over a decade. “Being treated this way can affect your mental state.”  

Klerck, who has lived in Taiwan for a total of eight years since 2005, points out absurdities resulting from his lack of a disability certificate, such as being unable to have blind assistance devices installed on a busy crossing near his home. Klerk has volunteered for a blind non-profit in Taipei, giving talks on assistive technologies for people with impaired vision. Yet he is not allowed to attend other classes offered by the same non-profit because he lacks the required certificate.  

Crossroads teamed up with South African Andrew Klerck (third to left) to advocate for foreign residents’ right to disability benefits.

Kellenberger says being able to obtain a disability certificate would also signify the government’s formal recognition of her condition and the daily hardships she endures. “Taiwan is my home. I wish the government would recognize that and see that we have contributed and that we now desperately need help.” 

Excluded from the United Nations, Taiwan is unable to be a signatory to the Convention on the Rights of Persons with Disabilities and the Convention on the Rights of Children. Still, Crossroad’s Chen emphasizes that Taiwan has enacted local laws stating it will adhere to the stipulations of those conventions.  

“So basically we signed up to be a nation that respects human rights, and that we would take care of everyone,” he says. “Those international conventions enacted into local law have the same power as law enacted by parliament. So what the MOHW is doing now is illegal.”  

The cost of exclusion 

Obviously, providing disability services to foreign residents will cost Taiwan money. But withholding them incurs other costs to society at large, “It’s not just about the actual person with the chronic illness or disability,” says Klerck. “Often their family members are Taiwanese citizens” who must cope with an immense financial and emotional burden. 

Cut off from services, foreigners with disabilities and their spouses may have to work less or quit working entirely. 

Crossroads is now urging the government to consider the long-term repercussions of excluding foreign residents from disability benefits, says Chang. “People who are disabled, who aren’t getting support, who are being ignored and turned away, their conditions will worsen… It’s all going to end up costing more to the national health system because you are not caring for a population that is vulnerable.”  

But that message needs to be communicated to the general public. Spending money on immigrants is a politically sensitive issue. Conscious of the ballot box, politicians may hesitate to initiate unpopular changes. 

This issue is illustrated by the struggle the Taiwan Centers for Disease Control (CDC) went through in 2017 to get approval for a pilot program to provide even Taiwanese nationals with  subsidized PrEP, or pre-exposure prophylaxis, a medication prescribed to counter the spread of HIV. The controversy came around the same time as a conservative backlash against legalizing same-sex marriage.  

“Some were arguing against same-sex marriage because they said it would bring HIV into Taiwan,” says Chan Pei-chun, deputy director of the CDC’s Division of Chronic Infectious Diseases. Before changes to the law in February 2015, Taiwan even required foreigners wanting to work or study here to test for HIV, deporting or denying entry to those who tested positive. 

By 2017, the issue of gay marriage had become so controversial that Dr. Chan’s department had to shelve the pilot program for a year until the third quarter of 2018. In that atmosphere, opening the program up to include non-Taiwanese citizens seemed out of the question. Despite the fact that many foreign residents are taxpayers, Dr. Chan notes that there was strong public opposition to spending government money on foreigners. 

Taiwanese citizens receive antiretroviral therapy (ART) for HIV from the CDC free of charge, while foreign residents must self-pay until the third year, when the National Health Insurance (NHI) begins to cover costs. (On paper, insured foreign residents and Taiwanese have the same access to NHI services as citizens.) The cost of self-pay ART averages NT$13,200 a month, according to health advocacy organization HIV Education and Research Taiwan.  

ART and PrEP have both played major roles in bringing HIV infections down in Taiwan, notes Dr. Chan. “HIV medication not only helps the patient, but it reduces transmission and the burden on the NHI because patients are likely to become less sick with the disease,” she says. In 2022, Taiwan recorded 1,069 new HIV infections, compared with 2,503 in 2017. Dr. Chan is hopeful that Taiwan is moving toward offering foreigners equal access to free or subsidized treatments based on the argument that it will significantly lower transmission. However, the same progress in equal access to disability benefits seems unlikely.  

Some foreign residents who deal with the discrimination say it is making them reconsider their choice to live in Taiwan. One of these is American Meagunn Hart, who came to Taiwan with her husband in 2009 and has a four-year-old daughter with cerebral palsy. Because Hart’s daughter, although born in Taiwan, is not a citizen, she is unable to apply for an in-home caregiver, obtain subsidized orthotic devices for her daughter, or enroll her in a preschool for children with disabilities.  

Hart says that because her daughter lacks a disability certificate, hospitals are not even allowed to inform the parents about where they can acquire orthotic devices. Each device costs NT$4,000-6,000, and as her daughter grows, the devices need to be replaced regularly. If the situation does not change, the family may be forced to leave Taiwan. 

“My daughter was born here,” says Hart. “She is for all intents and purposes Taiwanese. Even though she doesn’t have citizenship, this is her home. Right now, the differences are small, but as she gets older, she’s going to notice she’s treated differently. Everyone’s going to treat her differently because of her disability, but they are going to treat her extra differently because she doesn’t have the same access as a Taiwanese has, so she’s going to end up doubly ostracized. At that point our family… we would just have to leave.”