
How Taiwan transformed its health care system - Osiris30
https://www.nytimes.com/2017/12/26/upshot/the-leap-to-single-payer-what-taiwan-can-teach.html?referer=
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dustinmoorenet
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.

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Avshalom
While 200 USD is certainly cheap by comparison to the US costs, it's still not
affordable for a lot of people in this country.

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dustinmoorenet
People in Taiwan have the option of paying for insurance, which would make the
costs even lower.

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peterburkimsher
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!

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LammyL
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.

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distances
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.

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Symbiote
That cost me €500 in the centre of Copenhagen, there are probably cheaper
dentists in Denmark.

It took a bit longer for me, a second dentist came to help towards the end.

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cilea
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.

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geomark
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.

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itsZero
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)

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arcticbull
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.

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anonymous_fun
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.

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ilamont
A couple of anecdotes to share.

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.

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gurkendoktor
For balance, this is a good summary of the issues that Taiwan's NHI system
faces:

[https://english.cw.com.tw/article/article.action?id=1662](https://english.cw.com.tw/article/article.action?id=1662)

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.

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calcifer
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.

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jklepatch
I live and work in Taiwan. A tooth cleansing is about 7 usd, with insurance. X
ray is 30 usd.

In France, my country, a tooth cleansing is closer to 60 usd, and a x ray is
closer to 70 usd. I guess in the US its even more.

Super satisfied with Taiwan healthcare system!

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sytelus
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.

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yellow_postit
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

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sytelus
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.

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Symbiote
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).

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Feniks
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.

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Symbiote
There is private health care in the UK and Germany. Presumably others, but not
all EU countries.

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polskibus
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.

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gurkendoktor
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](http://focustaiwan.tw/news/atod/201403250026.aspx)

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ram_rar
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.

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replicatorblog
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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known
Q.

How much do people have to pay?

A.

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.

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chiefalchemist
> "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.

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dba7dba
If anyone is interested in getting to know about healthcare system in a
neighboring Asian nation, South Korea, here's an article you may enjoy.

[http://askakorean.blogspot.com/2010/01/healthcare-system-
in-...](http://askakorean.blogspot.com/2010/01/healthcare-system-in-
korea.html)

It seems to be an efficiently run program.

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aero_sm1th
Taiwan, and ergo Singapore, have an ideal health care system.

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Avshalom
ergo is definitely not the word you want there.

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gbacon
_Taiwan has a growing physician shortage …_

This does not seem like a positive lesson.

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mc32
>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, in contrast, revamped its top to bottom.

Sorry, "its" what? Copy editors, please.

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xtony
>Sorry, "its" what? Copy editors, please.

Imagine the sentence "Alice tinkers with her health care system. Bob revamped
his." It's the same concept, but with "its" as the pronoun.

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mc32
Sure, but I expect the NYT to use native Eng speakers who understand that
"its" does not work that way. It's just sloppy of them.

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temp
>that "its" does not work that way.

Can you expand on what the mistake is?

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mc32
It's missing the antecedent. So for this to make sense in Eng it should read:

Taiwan, in contrast, revamped its [own|healthcare|something] top to bottom.

Otherwise it looks like "Taiwan, in contrast, revamped its [top] [to [the]
bottom]."

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temp
> _It 's missing the antecedent. So for this to make sense in Eng it should
> read:_

It's not missing the antecedent, it's near the end of the previous sentence,
just like the other person you replied to said.

 _Singapore, which we wrote about in October, tinkers with its health care
system all the time. Taiwan, in contrast, revamped its top to bottom._

The _its_ clearly refers to _health care system_ from the previous sentence.

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mc32
True enough. It's just not common usage to use "its" as an absolute possessive
like that. Whereas other possessives lend themselves to that usage.

In other words it's typically used as a possessive determiner in this
construction.

It's somewhat similar to the following:

-Have you eaten?

-Yes, I've.

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yellow_postit
And thus your first statement gets completely overshadowed by a minor, and to
me meaningless, grammatical discussion.

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whatyoucantsay
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.

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kevinjcliao
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.)

[1][http://www.taipeitimes.com/News/editorials/archives/2016/04/...](http://www.taipeitimes.com/News/editorials/archives/2016/04/26/2003644828)

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keithpeter
Thanks for contributing, quote from OA

 _" 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.

