While visiting my in-laws in Taiwan (Taichung City), My son slipped on the floor and busted his head just above the eye. We took him to the ER. He got 7 stitches and occupied an ER bed for 4 hours while the drugs they used to put him under wore off. We paid after we were released. It came out to about $200 US total, without insurance. We got back to Austin a week later and had the stitches removed, which cost us $60, with insurance. Our kid's doctor, who removed the stitches, said they were beautifully done.
Taiwan's healthcare system is not perfect, but at least I don't have to worry about it. It is good AND affordable.
When I visited Taiwan, I needed to get some urgent dental care done. I went to a small local clinic, where the dentist spoke good enough english, did great work (including x-rays) and my total uninsured bill was less than my co-pay in the US would have been.
The average American dentist earns $175,000, the median is ~$155,000. What do you propose to do about that to reduce their income considerably to bring down overall costs vs what a dentist in Taiwan earns?
US GDP per capita is nearly three times that of Taiwan, incomes are likewise far higher.
It's equivalent to comparing costs in Switzerland versus Czech and being surprised that Switzerland is so much higher.
Price controls is a dirty term we refuse to talk about in the good 'ol USA. Most other healthcare systems in the world with low prices have some kind of combination of it when it comes to drugs and procedures performed. The AMA has been fighting any kind of single payer system for 50 years now. They know that a single payer system will result in some kind of price controls. On one hand you understand their point of view (maximizibf their income well being) and on the other hand you understand the issue with that for all of society.
Having said that it's not just the income of doctor. Healthcare administration is expensive in the USA. Many doctors offices spend a non insignificant amount of money on just the billing, collection, insurance administration. The health insurance system as we naturally ended up with sucks up a non insignificant amount of money out of the system. It also leads to these weird distortions where every insured procedure is discounted to the insurance agency like 75%... But not if you deal direct.
Additionally, operational insurance (malpractice indurance) is another non-insignificant contributor. Our culture and our legal system ensure that many doctors practices will pay a multiple of a practitioners salary in malpractice and related salary.
If we want cheaper healthcare all of these need to be addressed one way or another. I am not hopeful that we can escape this local maxima that we're stuck in. Every attempt at change will be meet with fierce opposition from the current status quo.
I did enjoy getting an x-ray (ankle injury) + evaluation + a week of painkillers for $27 USD without insurance, though. I can only imagine what it would have cost in the US.
When a ship is off course, you correct. I don't see either party letting healthcare slip under their respective watch. Taiwan's two party system does not have a (major) party built on small government like the US does. Both parties want to keep their people honestly happy.
Culture helps - everyone here wants to be a doctor, lawyer, or engineer.
Taiwanese doctors don't get paid in money.
They get paid "credits" which have to be exchanged for money based on a parallel financial system.
Foreigners here sometimes complain that there's a focus on seeing more patients faster, so there might be a misdiagnosis or a less thorough examination.
The fact remains though - it's cheaper to fly here to have a wisdom tooth removed (without insurance) than the same operation would cost in Switzerland or the US. There isn't much resentment of medical tourism either - so, you're all welcome to visit!
A blockchain-based currency would be cool, and not totally different to the current system.
All I know is what a medical student at church told me - I'll have to confirm later. But I know that it's not payment as status - the doctors' salaries are set in a parallel currency, which has a changing exchange rate with real NTD. I'll find out and reply.
I think Germany has a similar system, at least for dentists. A simple check is 1 unit, root canals have more units, and the insurance sets the rate how many Euroes a unit costs...
Ok, I found out that what I heard about was the balance insurance premium, which adjusted from 4.25% to 4.55% to 5.17%. But I also think I heard that it affects things like years to work to pay off student debt, and retirement. So I think there's more to it. As I remember, it sounded like a parallel currency where doctors fees are tightly regulated, and these "exchange rates" determine their actual salary. But maybe this is my financial ignorance showing.
I have encounted free general practice doctor places in Australia that operate on seeing as many patients as possible. Basically useless if you have a difficult to diagnose problem, but very useful for getting a referal, a script for a pill, or antibiotics.
This is how many GP offices work in the USA as well, especially in urban areas or offices associated with hospitals.
Unless you already know what kind of specialist you need to go see, and you can afford to go see the right one (might involve multiple visits to multiple specialists), you might literally never get help for a chronic problem that is not obvious on a differential diagnosis.
There really needs to be two kinds visits available: quick visits and check ups, and diagnostic visits. The first can be over in 10 minutes, the latter should last a solid hour.
I'm starting to wonder if "diagnostician" should be a separate specialization. Then I could make an appointment specifically to go see the diagnostician, and not bother the general practitioner, who is evidently too busy to spend more than 15 minutes diagnosing something.
This would only work if there were a mechanism to pay for diagnosis.
Internal medicine specialists are supposed to be "diagnosticians," as you envision it -- they have more training than general practitioners if they're internal medicine specialists. But they're one of the lower-paid specialties, in part because it's easy to charge for a stent or injection but in the US the act of diagnosing a problem doesn't really have a code.
My old GP (now retired) called himself a "diagnostician", and never spent less than an hour on any visit. He'd ask a lot of (prying?) questions about home-life and work-life and social-life as part of getting a holistic view of you...
He also didn't take insurance - because he didn't want to bother with it. And he wanted to be more honest in his notes than his libertarian heart felt comfortable disclosing to the insurance company or the government payers.
Yeah, pros and cons. GP visits are subsidised a set amount by the govt down here, and while for some doctors that means squeezing in as many visits as possible to get volume, for others it just means they get $X from the government and charge the patient an extra $Y for each visit. Many are happy to pay a premium.
Isn't that how all non-Veterans Administration medical care in the US works? Genuinely curious -- my understanding is that almost all medical care profit in the US is driven by volume of procedures, and even non-profit care is reimbursed by insurance companies according to procedures.
How much does it cost to get wisdom teeth removed in the US and in Taiwan? My dentist in Toronto charges around $400 CAD per tooth for extractions, and that’s with full general anesthesia. The price is the same here with private insurance and without.
I have a missing tooth and I'm getting an implant to replace it. Last week I had the post installed. It took about an hour and cost $4200. Insurance covered only the pain meds.
After that's healed, I have to get a replacement tooth mounted on the post and that's another $2000ish. I believe my dental plan will cover $1000 of that.
I don't understand how an implant can cost $4000. It was an hour of time in a dentist office. It seems about an order of magnitude too much. FWIW, I had two estimates and that was the lower one.
$5 USD (150 NTD) with insurance at a clinic, up to 400 NTD at a hospital.
Compared to over $400 USD insured in the US.
The cheapest SFO<->TPE flights cost $468.
It might not work out cheaper for you, depending on your insurance plan, but it should be thought of as a serious option for all non-emergency operations.
I'm wondering the same. In Germany my wisdom tooth removal took 20 minutes with local anesthesia included. It was fully covered by the regular compulsory health insurance so I don't know the cost, but seems like quite a small operation to me.
In Bangkok I got two wisdom teeth removed in a single operation with a local anesthesia for $300 without insurance, in a good modern clinic where everyone speaks English.
Chap I worked with used to fly back to Terhan for his dentist as well as visiting family - said his old dentist was cheaper and better than UK. Just wondering if part of that is simply cost of living difference?
Sure. A lot of medicine is pretty much a simple service business, economically. You are paying for the services of a person. These tend to be very locally priced.
But.... Medicine is not really an ordinary market, most places. It's not really a market in the US and Europe, in the sense that prices are set like other services. A big determinant of costs tends to be how well the system works.
Well UK dentistry has a different treatment philosophy than the USA for sure.. not sure if Iran is the same. The UK would claim the US overtreats. This is changing though due to private insurance va the NHS and a desire for white straight teeth.
I'm planning on visiting to get some dental work done in the coming months. I have a lot of issues and have never been able to afford proper work here in the US. To get the work done I need here would be in excess of $50,000 but my friend in Taiwan said it would cost at most $1,000 there.
Every time in the past I suggested something like that to my current dentist they had the same reaction, basically:
"Oh I would never do that! You're going to get an infection and/or they are going to do such bad work that no dentist here in the US will want to touch you afterwards."
Doctors in the US are so arrogant, thinking they are the best in the world because they are the most expensive. I would love to move to Taiwan, but I suffer miserably in the jungle weather (hence why I am going in winter).
Edit: As someone with chronic health issues in the US, I have a laundry list of horror stories about doctors here. They are far, far from the best in the world.
As a U.S. based software engineer, I can say that medicine is not the only sector that has over-priced professionals. I get paid a ridiculously high salary compared with my European counterparts. I've honestly always wanted to move to Europe, but the salaries here keep me from doing so. I don't understand how the U.S. gets away with it, to be honest.
With a global economy, I don't understand how we manage to stay competitive. Same goes for Silicon Valley vs the rest of the U.S. I don't understand how there can be such a price differential, and yet the most pricey places seem to win economically.
Taiwan's health care system is quite comprehensive, coverage includes annual eye examination, teeth cleaning, etc. And, I don't remember paying much for it.
People usually go straight to the hospital instead of visiting their family doctors. Most checkups (e.g. X-ray, blood check) are done at the hospital; no need to do mulitple trips. I actually prefer Taiwan's system over Canada's.
The thing is, Taiwan's system is relatively newer (the same with their subway). It is difficult to compare.
Are these hospitals private or public? The experiences posted in this thread are very similar to my experiences in Thailand at private hospitals which are really nice world class facilities with mostly very good doctors. The public hospitals, however, tend to be way over subscribed and quite poor quality in service and facilities. I'm wondering if there is a private versus public hospital divide in Taiwan.
Both. The best hospital is a public one and tons of smaller or local hospitals run by both private (usually non-profits) or public. I think the smaller public one do suffer from resource shortage but fair service and quality are still expected and available. (but i live mostly in the city, I do imagine remote area would have some problems)
I was visiting Taiwan a few years ago, and one of my friends busted open his lip. We went to the ER in Taipei (without insurance) and they saw him within an hour or so, prescribed some antibiotics, filled the prescription on site and sent him on his way. Total bill was under $20USD all in.
My Taiwanese relatives and wife see the US healthcare system as a big PITA, and from what I have seen of both sides, I agree. Insurance in the US is no guarantee you will get healthcare, will not go broke because of it, or die waiting for it.
My wife went back to her hometown in southern Taiwan a few years ago to help take care of her ailing father. One day while at the hospital she saw a tour bus pull up, and forty tourists from mainland China disembark. Their tour of the local sites included a checkup and some tests by the doctors in the hospital. Works out well for them and the hospital, which is not nearly as busy as the facilities in Taipei.
People clogging up emergency care facilities with common colds and minor ailments is common (as noted by others on this thread). There are several negative side effects including patients expecting to be prescribed something even if it's not warranted. If it's antibiotics, that's a problem because people can build resistance to antibiotics. I also believe there can be a kind of assembly-line mentality taking over among the staff at some busy facilities, with doctors spending only a few minutes with each patient. This can unfortunately lead to truly serious cases being overlooked.
For chronic conditions, the quality of care varies quite a bit. One complaint I've heard several times is sometimes there is no coordination between specialists -- it's up to the patient or family members to reach out and make appointments and communicate test results and the conclusions of other doctors. Lots of things can go wrong, and I fear some patients fall between the cracks.
Dental care can be very good and very inexpensive - my dentist here in the U.S. has complemented the skills of the dentists back in Taiwan who put in crowns years ago.
It matches the complaints I've heard from several nurses quite well. Idiots with a harmless common cold clog hospital waiting rooms just because it's cheap and convenient. Not just doctors, but also nurses are underpaid and will jump ship if they can.
Indeed. I prefer the Dutch system. Here, if you go to a hospital without a) being sent there in an ambulance via a 112 call or b) being referred by your GP ("huisart") insurance won't cover anything. It works wonders for keeping idiots from emergency rooms.
This is interesting because there is so much conflicting information. On one hand several people mention they received timely inexpensive care in single-payer system and on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option. It appears that Taiwan's system is certainly getting stretched now and they have been putting up new constraints and caps. My main worry is that in single-payer you have zero options. If your "payer" decides to put a new rule (for example, only cover treatment X because Y is too expensive), it applies to you whether you like it or not and there is nothing you can do about it. Further, in single-payer there are virtually no incentives or restrictions on what they would and can do because its a virtual monopoly. For example, government can decide to reduce budget on health care because they must spend more money on defense due to some foreign threat.
Well its not the government who decides what is covered or not. Most countries have special boards with doctors who decide what is covered by the basic mandatory health care insurance plan.
But at the end of the day society has to decide whether or not healthcare for everyone is something worth spending money on. And that's were the US fails imo: no sense of a shared community.
While that's probably true, it's difficult to have a comprehensive individual patient cost comparison because medical issues are so diverse, and some people do indeed consider some issues to not require immediate attention. But I imagine only a financially unhealthy government would strip the health care system's funding for all things that the general population considers a basic requirement. And if your government has financial straits that dire, you're going to have so many problems in all aspects of life, not just health care. What's the point of being healthy if everything else is a living hell? Not saying this is a good argument for or against single payer. I am saying that whether or not single payer should be the system is probably an unimportant question for an insolvent government's populace.
> on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option.
These seems to most often crop up around non-critical issues like joint paints etc.
And i have yet to find a single payer system that do not let you go abroad for elective care, if you can find the funding. They will however not fund your trip unless there is a strong case made for there being no viable alternatives back home.
With most US based insurance being employer based I don't see how the "we only cover x because of y" really is a discriminating function between single payer vs multiple. My ability to choose an employer based on their health care plan is challenging at best. I may be missing something however as I mostly know the US system
If you have good top tier employer, chances are that you have pretty good insurance. Medical insurance is actually a criteria for lot of people for which employers to work for. This however probably applies to more skilled workers who have such choices. In single-payer, your employer no longer provides insurance. So everyone gets same plan and you are stuck with it.
A top tier employer in Europe may still offer private health care insurance.
When my father had cancer treatment, he sometimes asked for the public hospital (shared ward, less lonely when he was feeling OK but had to spend days in a bed) and other times the private hospital (doctors and nurses had more time, but the treatment was the same and he had a private room).
Cultural difference. In my country everyone gets the same standard of healthcare. If you think you think you deserve special treatment just because you're rich you can fly to the US or Singapore. Strangely enough most rich people don't.
Yup, the idea for for profit driven healthcare sounds bad until you consider the alternative which is cost minimization driven, the easiest way to cut costs is to not provide service
Indeed. My understanding is that US hospitals will inflate their bills because they know the insurance companies will turn over every stone to find ways to drive the bill down.
This in turn bites those that try to pay directly, as they end up with sticker shock.
What are the opportunities for Taiwan healthcare workers to emigrate? Sometimes the surprising quality comes from lack of perspectives for the workers (for example strict visas requirements in contrast to EU free labour movement). Many very good doctors from Central and Eastern Europe emigrated and the quality of healthcare dropped.
When I went to Taiwan in 2009, several people told me that Taiwan exports lots of doctors to China. Here's the only reference I can find right now: http://focustaiwan.tw/news/atod/201403250026.aspx
This exists, but not much. As a matter of fact, many healthcare workers (especially registered nurses) work very, very long hours and get way less paid than they do in other countries. Also I would expect quality of surgeries would drop in future years due to lawsuit or lack of trust between doctor/nurse-families of patient causing doctors/nurses quitting.
I had half of my toe nail severed off due to a bathtub mishap. I dint have first aid kit at home and rushed to minute clinic at CVS near my house. They charged my insurance whooping $150 to bandage a wound... I dint have to pay anything, but I felt this was way tooo excessive.
My daughter was diagnosed with Leukemia, spent 10 weeks in a top-notch hospital, got stellar around the clock attention from the best docs in the world for two years, and a limitless supply of chemotherapy and drugs to treat the side effects.
Grand total for 24 months of the best care in the world?
$8,000 in deductibles.
I don't doubt that other healthcare systems are well run, but after my family's ordeal, I came away pretty impressed with our system. Treating cancer for less than the price of a well-worn car is pretty darn impressive.
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If you’re employed, your employer pays 60 percent of your premium. The employee pays 30 percent, and the government subsidizes 10 percent. The government fully subsidizes the premiums for the poor and gives partial subsidies to veterans, the self-employed and farmers.
Q.
How much is the typical premium?
A.
The total insurance premium for employed workers is 4.6 percent of wages. That’s much lower than in the United States, where the average is between 12 and 20 percent of wages for those who are covered by their employers.
> "Taiwan has done a great job at treating many communicable diseases, but more chronic conditions are on the rise. These include cancer and cardiovascular and cerebrovascular disease, all of which are expensive to treat."
It's foolish to keep talking about healthcare without talking about (personal) health (including diet and lifestyle).
Reforming the healthcare system of a relatively young and healthy society is relatively easy (read: doable). On the other hand, "fixing" a healthcare system of a country (e.g., USA) that's aging and more importantly fond of "acquiring" preventable conditions (e.g., obesity, type 2 diabetes, etc.) and you will always be going sideways.
Yes, there is room for improvement in the USA. But that's still not going to fix the disgusting amount of resources wasted on the preventables.
If healthcare is going to be a right then personal health is the responsibility that must be paired with this right. Thus far the USA isn't interested in the discussion of the latter.
>Today, most hospitals in Taiwan remain privately owned, mostly nonprofit. Most physicians are still either salaried or self-employed in practices.
What they didn't mention, is that often med students get their studies paid by one of the hospitals and then are tied to that hospital up to 7-ish years at depressed salaries --which is likely contributing to the shortage.
Taiwan does indeed have world class health care despite having an exceedingly low tax rate by western standards.
But lets not overlook the elephant in the room.
Taiwan is an island full of thin people who eat rice or noodles at almost every meal. Millions of people still shop primarily at traditional markets and millions of others follow Buddhist diets that would be mocked by western "diet hackers". Only in the past generation has it really begun adopting, and suffering the effects of, western eating habits.
If Taiwanese people ate like Americans and drove everywhere, their health care system would have become bankrupt years ago.
Hi there! Taiwanese here.
We invented boba (full of sugar and unhealthy), and our cuisine, while delicious, can be incredibly unhealthy. We are actually struggling to confront one of Asia's largest obesity epidemics. I think the notion that we're an island "full of thin people who eat rice or noodles at almost every meal" is not only a problematic and reductionist characterization, it ignores the problems that we face (an epidemic of obesity and an aging population.)
"Finally, it began to institute global budgets — caps on the total amount paid for all care — in the hope of squeezing providers into becoming more efficient."
OK, what happens when a part of the system hits the cap in a given year? Rising obesity -> cancer/blood pressure/type 2 diabetes in a decade or two based on UK experience. In UK we spend a large % of GDP on the NHS but that % can't keep rising forever, so I'm interested in alternatives.
I don't consider it surprising that a Taiwanese would use characteristically un-Taiwanese expressions on an English-language forum. I'm not sure what to think of your approach of suggesting that they are lying, but then self-congratulating your charity for not outright saying that.
While rice and noodles may be staples of Taiwanese food, that doesn't mean that everyone is eating healthy. In the West, you might say the same about wheat flour and potatoes, but when that flour comes in the form of burger buns and cake, and the potatoes in greasy fries, it doesn't seem so healthy.
I don't know how often Taiwanese drink sugary drinks or eat sweets in addition to their meals, nor do I know how much of that rice and those noodles are fried as chow fan or chow mein (and apologies if those are not the words Taiwanese would use), but it isn't hard to imagine that it is more than optimal. That's usually what happens when people are able to afford more food than they actually need, and are able to choose tasty high-calorie high-fat meals whenever they feel like it.
I've bent over backwards to remain charitable even after receiving uncivil and ideological barbs such as "problematic" and "reductionist characterization" flung at me in the midst of an exceedingly dubious comment.
Jamie Oliver did a show in the US and kids didn't even know what some vegetables were. Jamie showed them potatoes, tomatoes, carrots they may as well been alien the kids didn't have a clue. https://www.youtube.com/watch?v=bGYs4KS_djg
Don't know why you're getting downvoted, but to support your point, they consume waaaay less caffeine and alcohol than the u.s. most are allergic to alcohol. Missing sleep isn't a competitive sport. Their bodies are much more homogenous and obesity I estimate less than 3%.
Also in corporate cafes, foods are still very traditional.
Notably their eyes are relatively poor. Almost 90% have corrected vision. Often in large meeting 100% will be wearing glasses.
Taiwan's healthcare system is not perfect, but at least I don't have to worry about it. It is good AND affordable.