Taiwan’s National Health Insurance (NHI) system has long been a source of pride for Taiwan. However, the healthcare environment faces severe challenges due to long-term underinvestment and the significant increase in demand resulting from an aging population. The healthcare industry is confronted with serious shortages of medication, healthcare professionals, and investment. 

In 2023, the International Research-Based Pharmaceutical Manufacturers Association (IRPMA) published the 2023 Taiwan Health Investment Report, which revealed that while Taiwan performs well in various health indicators, there is still room for improvement compared to advanced countries. For example, when comparing standardized mortality rates for the top 10 causes of death in Taiwan, such as cancer, cerebrovascular diseases, and diabetes, with those of Canada, the UK, Germany, Japan, and South Korea, Taiwan’s standardized mortality rates are higher.  

Furthermore, according to the Universal Health Coverage (UHC) index proposed by the World Health Organization, which assesses the extent of basic health service coverage and financial burdens, Taiwan lags behind these countries, indicating that there is potential for improvement in Taiwan’s ability to protect against major diseases. 

Despite Taiwan’s pride in its NHI system, why have these outstanding achievements not been reflected in various indicators? The 2023 Taiwan Health Investment Report analyzed global data and found a correlation between healthcare expenditure and national health levels. Countries with better life expectancy and lower disability-adjusted life years (DALY) due to cancer generally have higher levels of public healthcare expenditure.  

However, Taiwan’s public healthcare expenditure, which includes expenditure on medical services and pharmaceuticals, accounts for only 6.1% of GDP, significantly lower than the OECD average of 9.6%. 

Taiwan adopts a global budgeting system for its NHI, which has the advantage of controlling expenditure but has the disadvantage of severely affecting the development of the healthcare industry and inhibiting the application of new technologies. In Japan, up to 95% of new drugs are covered by health insurance, with waiting periods for coverage being less than 60 days. In contrast, the average time for new drug coverage to take effect in Taiwan exceeds 700 days, with only 55% coverage for new drugs on average between 2014 and 2021. Fortunately, the National Health Insurance Administration has since 2023 been working to expedite coverage of new drugs and has introduced a series of reform measures. However, due to budget constraints, support from all sectors is still needed. 

Starting from 2025, Taiwan will officially become a super-aged society, with over 7 million people aged 65 and above. It is estimated that the annual healthcare expenditure for the elderly will exceed NT$620 billion. Faced with foreseeable challenges to the healthcare system, increasing investment is imperative to actively move towards the common goal of creating a resilient and sustainable healthcare environment. 

The mindset over the past twenty years has treated healthcare expenditure as a cost. Since it is considered a cost, efforts have been made to save, resulting in the system struggling with limited resources. Only by viewing health as an investment can we break free from the increasingly heavy burden of healthcare costs.  

“Investing in healthcare not only enhances public health and hygiene but also brings about economic, fiscal, and productivity growth, strengthens the international alignment of healthcare systems, fosters innovation in the biotechnology industry, and enhances national competitiveness,” says IRPMA.  

The benefits and impact of investing in healthcare go far beyond health itself. The World Health Organization has repeatedly emphasized that spending on better health is an investment, not a cost. 

Regarding health investment policies, IRPMA proposes the following recommendations: 

1. Expand diverse sources of funding for the NHI and improve the efficiency of resource utilization with a consensus on health investment. 

2. Reference international standards to increase healthcare expenditure, setting Japan’s healthcare expenditure of 11% of GDP as a long-term goal and gradually approaching the OECD average of 8-9% as a short-term goal. 

3. Improve accessibility to new drugs to enhance national health and strengthen the international alignment of Taiwan’s healthcare system and competitiveness in the biotechnology industry. 

4. Establish an inter-ministerial task force under the Executive Yuan to make increasing health investment and improving health indicators part of the government’s wider policy goals, promoting collaboration across all government agencies, and continuously gathering opinions from civil society groups. 

Building a resilient and sustainable healthcare environment is a long-term proposition, and reform is not something that can be achieved overnight. However, there is still significant untapped potential in Taiwan’s healthcare system, which requires a paradigm shift towards viewing health as an investment. A comprehensive review of Taiwan’s current healthcare expenditure is necessary to enhance Taiwan’s healthcare protection, align with international standards, and safeguard the health of the entire population.