Comparison of Health Care System of Taiwan and USA
Health care systems are intended to meet health care needs of the people or populations (Swann, Carmona, Ryan, Raynor, Baris, Dunsdon, Huntley, and Kelly). Health care reforms are required in order to modify the health care systems for making them capable to operate more effectually. There are however a wide variety of health care systems around the world. In some countries, the health care system has been formed but they are not planned, contrary to it in some countries a determined effort has been made by trade unions, governments, religious, charities, and associated bodies in order to deliver organized health care services to the targeted populations (Cristian). In this paper the health systems of Taiwan and United States of America are compared and detailed explanation of systems of both countries is given.
History
In Taiwan, the health care system was properly improved in 1995, when universal health care system was established and National Health Insurance program was introduced through which approximately 96% people become insured (Cheng). At that time bulk of health care facilities were provided in Taiwan, approximately 86% hospitals in 1999 and 65% hospitals with bedding arrangements in 2000 were privately owned and they were non-profit hospitals (Romeis, Liu, and Counte). However, in 2000, nearly half physicians in Taiwan have their independent clinics of their own in which they practiced and provided medical facilities and treatment to patients (Yang, A Huang, and A Hsueh). And from that onward many innovative reforms were introduced in Taiwan’s health system such as smart cards for the ease of patients. It is estimated that about 20,000 clinics will be further opened by 2016 (Chan)
The Health maintenance Organizations in United States flourished widely in 1997 in order to provide advance medical treatments to the patients (Cutler, Glaeser, and Shapiro). Then onwards the health care system went on improving and the present day health care system is emerged. The various aspects of health care systems Taiwan and United States are described below.
Model Followed by Health Care System of Taiwan
Taiwan’s health care is one of the much praised systems in Asia. It has single payer insurance structure in the system, the approval of which was passed in 1995 (Adams). Single payer is a system in which the government compensates and reimburses hospitals and doctors for health care costs. This system does not eliminate free competition in the market. Taiwan follows collaborative health care model in which the medical practitioners passes through three phases i.e., role ambiguity, acquisition of role and implementation of role in order to provide health care facilities to the patients (Mu, Chang, and Tsay). In Taiwan, the health provider work in the market crowded with the private and public facilities that fiercely compete for the patients. But here due to standardized fees reimbursement the hospitals and doctors do not compete for the price. The country has also instituted scheme of national health that emphasize on the pay of citizens into the national health insurance fund that is controlled and monitored by government regulations (Chi, Lee, Tsai, and Chen).
Whereas in U.S., if health care system is analyzed then we come to know that most of the hospitals are privately owned. Approximately 60-65% of the health care and spending in United State’s health care comes from Medicaid, Medicare, TRICARE, Veterans Health Administration and Health insurance programs in Children (Potter and Vistnes). In United States, Patient centered medical approach or model is being followed (Rittenhouse and Stephen M). Under this model, the patient centered medical are being promoted increasingly as a model for improving the care so that it may address several failures and gaps in delivering, which are prevailing in the current health care system (Bates, and Bitton). In United States people pay for the medical facilities largely through insurance and the price is determined either by free market setting of price between the payers and providers, through negotiations between them or many be settled by the government (Reinhardt).
Structure of Health Care System in Taiwan
Taiwan’s Healthcare is managed and regulated by the Bureau of National Health Insurance i.e., BNHI (Griffiths). Additionally, this system is typified by the centralized management. The Executive Yuan’s Department of Health formulates the policies regarding health and also supervises delivery of the health services. The public sector however plays chief role in the financing and delivery of the healthcare services. Moreover, the program maintains obligatory insurance facility for the citizens who are impoverished, employed, unemployed, and victims of the natural calamities. The fees however correlate to the family or individual income. Further, it also assures protection for the non-citizens who are working in Taiwan. A standardized calculation method applies to all individuals and can optionally and decisively be paid by an individual or by employer contributions. Whereas in United States, the structure is that that the health practitioners go into the market after getting certification from the private institution that allow them to practice in a hospital or conduct their own practice or join the accessible practice. The hospitals and practices are however generally private but the state and local governments provide funds to the practices and hospitals operating publically. Moreover, the insurance in United States is also purchased through private insurance companies, which is managed quite differently in each state (Giang). This is making the generalizations about American market of health insurance difficult.
Taiwan has adopted a self sufficient health system. The structure is that it collects premiums i.e., insurance premiums for sustaining expenditures in order to purchase health. The BNHI however collects the premiums from the insured or beneficiaries, which are the people enrolled in National Health Insurance Programs and issues insurance cards known as Smart cards to them. When insured seeks medical services or facilities, they do not have to pay for any medical expense, instead a copayment or a medical benefit as a fee of user. The medical providers can then make claims to Bureau of National Health Insurance for reimbursing the services they provide (Chan). The infants are also covered in this program immediately after their registration and confirmation of birth in the registration office of the local household. The providers of the health care in Medical care institutions are on contractual terms.
Their claims can also be reimbursed from Bureau of National Health Insurance on fee on the basis of services or initial design. BNHI however contract various pharmacies, Western and Chinese medical hospitals and clinics, midwifery clinics, laboratories and psychiatric facilities providers. The contracted rates are usually high because BNHI keeps a regular check in order to prevent any illegal activity, deception and fraud. As far as financing of National Health Insurance is concerned, the premium rate is fixed in the beginning, and then it may be adjusted depending on the reserve fund amount. The reserve fund is however converted from from balance after the deduction of the expenditures associated with healthcare from the collected premium (Rachel Lu, and Hsiao). The health care structure of the country is shown below with the help of figure 1.
Figure 1: Health Care Structure of Taiwan.
Source: PWC, Checking up on Taiwan healthcare: Market challenges and opportunities, June. 2012, Web
Philosophy of Medicine in Taiwan
The philosophy of medicine in Taiwan is that medicine emphasizes on prevention instead of cure and considers the cause of illness as weak energy level that can be treated with the medicine that give strength and restore the body mechanism. It also focuses on promoting and encouraging wellness and providing treatment of diseases by detecting imbalances and disharmonies and restoring balance and harmony. The agents responsible for causing disease are considered as belonging to same world as treatment and body is not a matter of getting rid of them or killing them but restoration of balanced and impartial place in the world.
Further Taiwan considers preventive medicine technique which is the core philosophy of R&D in the country. It comprises of R& D of the antioxidant components and R&D for improvement and prevention of the diseases associated with lifestyles. The products such as ADV Healthy and Sugar Resistant Tea, AGV Honey Tomato Drink and AGV Healthy & Oil Trim etc all are the result of hard work of the R&D team. However, United States also invests in R & D for medicine ad for providing better solutions for curing the diseases (Glennerster, and Kremer). The country is controlling the political and other issues in order to spur the production of medicines.
Annual Expenditure of Country on Health Care
The administrative cost of Taiwan is low and is even below 2%. The country spends 6.3 percent of GDP on the health care expenditures and above 80 percent Taiwanese population is satisfied with the system (Lodish). The average annual premium is only $650 for a family having four members (Dorfman). The Smart cards that are issued to insured residents contains history as well as medication of the patients and it bills fund of national insurance automatically that helps in the reimbursement of expenditure and helps to reduce the cost. In United States, much more is spend every year for the health care such as it is estimated that in 2012, the businesses, household and government will spend about $ 2.9 trillion on health care that is 3.8% more than the expenditure on health care in 2012 (Young).
Issues Related to Health Care Cost in Taiwan and United States
The Health care system of Taiwan is facing criticism for the cost from several pharmaceutical companies, which consider that Taiwan’s reimbursement and pricing system is opaque and complex. Bureau of National Health Insurance set the prices of drugs and health care cost that is based on the international evaluation and comparison. They are usually set at the spectrum’s lower end; hence they have to face criticism from the international drug manufacturers. So, there is generally a gap between actual price and reimbursement price that is paid by the health providers and it results from the concessions or discounts offered by the manufacturers to the providers. They offer high discounts which are advantageous for the citizens of Taiwan due to lower cost and disadvantageous for the innovative drug producers at international level because BNHI usually set lower prices of drugs that are based on the international market comparison. Contrary to it, in United States it is claimed that unnecessary care is provided that has resulted in loss of billions of dollars and is resulting in the lost of productivity that is further raising health care cost (Binder).
Issues Related to Healthcare Access in Taiwan and United States
According to Taiwan Today 2013, Taiwan is however facing the challenges population that is aging quickly and of a decline in the birthrate there are expectations that the country will be regarded a super-aged country by the year 2025. However, the development among the medical specialties is quite unbalanced. The single payer system is the main system that is used in the country and this system fails to fully reflect the differences in the time of consultation in the same department and also in the different departments. In this situation, the cost differences in the different departments are not considered; it is leading to the imbalance in the medical expense structure, which is significantly affecting the medical services in the country (Chien, and Chen). But, in United States, Obama care is introduced instead of the single payer system. In Obama care, it is intended to provide insurance facility to all citizens (Sirota).
Moreover, there is an increase in the hospital care and ambulatory expenses. In Taiwan, the fee for service program is the major program and due to asymmetrical information the health care providers take an advantage of the medical information and obtain profits due to improper monitoring and transparency of the medical services. The referral programs were introduced for reducing the number of patients that seek medical treatment from the medical centers in the desire of attaining reasonable usage of the medical resource, but, it is not adopted enthusiastically because of the opposition from public who prefer the services of large hospitals and medical centers. A large number of the small and medium sized hospitals are however having a difficult time for running their businesses. Other issues that Taiwan is facing for providing healthcare access are over-usage of the health care, which are facilitated by the easy access to the medical facilities and treatment (Rachel Lu and Chiang).. Further, the healthcare providers are facing noteworthy financial pressure. There are also issues regarding continuing financing and sustainability of the National Health Insurance Programs of the country (Rachel Lu and Chiang). There is a lack of transparent regulatory frameworks in the rising and emerging areas such as medical tourism etc. Whereas in United States, the health cost is high and doctors are not paid according to care quality (Klien).
Stakeholder’s view for providing Health access to people
In Taiwan the stakeholders are suggesting to change the focus from profitability and volume of services provided, procedures, tests, visits of physicians and hospitalizations to the outcomes achieved by patient. They are further suggestive of replacing the current fragmented structure and system where each local service provider proffer wide services range with a system where services for specific conditions are concerted in the organization that deliver health. Further, they are of the opinion that the organizations should operate for delivering high value treatment and care. The government is however doing commitments for financing and considering it is prerequisite for susceptible population. The government is of the view that the citizens contribute and pay their share so it is the duty of government to shoulder their dependability and responsibility of safeguarding health of the deprived people of the society. They are further emphasizing the fact that effectual administrative policy is needed in order to extend the coverage in continuous and steady manner maintaining the dignity of the worldwide coverage policy. The government is however planning to start in order to ration the care for keeping spending aligned with revenues (Roy). Whereas, in United States, the stakeholders are demanding the access to the preventive care and they are also demanding insurance for all the residents, all of them agree upon the suggestion of encouraging mental and emotional growth of patient especially of children during their treatment (Bassok, Fitzpatrick, Loeb , and Paglayan).
Issues Related to Patient Safety
The shortage of healthcare staff, especially nursing staff has been a continuous problem in Taiwan (Eslamian, Taheri, and Mojdeh). Staff deficiency is creating threat for the patients as well as for medical staff. Presently, there is no effective policy of government for regulating the financial activities of the hospital. More and more corporations are joining the healthcare business and the rapid unrestricted commercialization is badly affecting the medical care quality and National Health Insurance budget. The country has many malpractices of medicine and this is shattering the trust between the patients and health providers. Several Taiwanese healthcare institutions refuse to give complete health checkup record to patients. The improperly diagnosed and unnecessary surgeries are however hurting rights of patient in Taiwan (Wu, Majeed, and Kuo). The drug prescriptions in Taiwan lack clear and complete information that makes patients vulnerable to the abuses. Due to the lack of proper regulation, the medicine bags in the country are not labeled with proper information.
The medicines of children are the customized version of adult’s medicine. Their quality and dosage varies with clinic but there is no obvious guideline and the health of children is under poor quality medication threat. The budget allocated for diagnosis of patients has not being utilized efficiently and the patients are getting poor treatments in spite of huge spending by government. In order to get profits many hospitals are turning into shopping malls, shopping alleys and food courts are expanding in hospitals and the safety of patient is being neglected and compromised. In order to cope with these issue Taiwan has adopted the strategies of prescribing proper medicine, execution and implementation of control of infection, elimination of wrong surgeries that are based on imperfect diagnosis, evading patient identification and recognition errors and preventing falls of patient. Patient’s rights are now also being considered and are given importance in Taiwan. Patient safety reporting system is introduced for voluntary complaint regarding health care (Lin, Shih, Liao, and Wung).Emergency treatments are also becoming popular the country. The country is emphasizing on providing sufficient quality and services depending upon the ability to define the rights of patient clearly during emergency medical treatment. In United States there are no such issues of proper labeling of medicine bags, imperfect diagnosis etc. attempts are also being made in United States for introducing accurate Patient Safety Reporting Systems.
Technology in Taiwan and Its Comparison with United States
Taiwan is using sophisticated technology to provide immediate assistance to the patients under health care system. The technology is so advance in Taiwan that since 1995, approximately 23 million people have been benefited and enjoyed comprehensive and universal health insurance coverage under single-payer national health insurance system that is financed by the payroll contributions from employees and employers subsidies from government (Reinhardt). But, the health care in United States is burdened by the poor and inefficient coordination, sluggish to communication that is nonexistent, and care and services duplication. In Taiwan the participation in the National Insurance system is compulsory and patients have their medical information in the form of the small cards (Senn). Considering the health care in United Sates, such facility is not available. The provider can share the information but it requires time. Moreover, the settlement of claims in United States under the private health insurance may take up to 3 months and for Medicare 3 weeks are required, but this is not the case with Taiwan. Taiwan has adopted proactive approach instead of reactive approach in order to cope with the problems that arise due to technology.
In Taiwan Health Insurance is mandatory and is provided to all the residents and citizens of the country. It is not a norm it has universal coverage and is available to all in Taiwan. It is offered and funded by public, private and government. About 62% is funded by public and government sector and 38% is funded by private sector. In Taiwan there are electronic health records cards for the citizens that allow them to trace the health records of people starting from birth. The electronic data also enables physicians in a hospital to access the medical record of the individual patient under strict privacy conditions. The record however also includes the birth records, outpatient records and their visits along with the prescriptions, summaries of discharge, laboratory tests and the digital images. But such data sharing facilities among the clinicians in various health care systems is unusual in the United States. Approximately half of the Taiwan’s health system is connected through the electronic record (Reinhardt). In order to access the file of the patient a physician’s digitally authorized signatures are required and particularly it is important that the patient in Taiwan swipe his/her personal electronic card or smart card through card reader on the desk of physician that authorize the access.
The card reader comprise of the slots for patients as well as for electronic card of physicians. It directly connects the patient and physician to the Bureau of National Health Insurance’s data centre. So, it enables the bureau to investigate and track the use of health care system in’ the real tine and to monitor behavior of patient and doctor (Reinhardt). But, in United States such behaviors cannot be monitored due to the lack of the electronic data record. Though technology is enriching the material life and is improving the living conditions but its speedy development and power may pave the way to several controversies in both the countries. These controversies include misuse of information, cloning, modification of genes, and computer crimes etc. moreover, these issues are inevitable as they are challenging the ethics and morals values of humans. Rapidly growing technology is leading to polluted environment and several unpredictable ethical dilemmas (Wang, Chu, and Lin). The traditional role is however becoming much more difficult in both the countries because these innovative technologies are transforming the human beings. In nut shell, Taiwan is doing a remarkable job in the health care system. It is also facing some challenges but trying hard to cope with these challenges.
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