Why We Should Increase Our Health Care Payment of National Health Insurance
Pic1. From 黃立佩 Lipei Huang's Facebook
During this COVID-19 pandemic, people around the world have realized how critically a mature healthcare system should be practiced. Overlooking the chart of Health Expenditure Per Capita and the list of Developed Countries done by Organization for Economic Cooperation and Development (OECD) in 2019, it demonstrates that a developed country tends to invest more in the healthcare system. For example, a Swiss paid for about 12.2% of one's GDP for health expenditure, compared to 3.1% in Indonesia, which is considered a developing country. In Taiwan, our National Health Insurance (NHI) covers most of our medical expenses, but we only need to pay 4.69% of GDP. The low payment for NHI contributes to the financial gap in NHI and the inequivalence in a doctor’s workload and their wages, so we must increase our healthcare payment of NHI.
The first reason we should raise our sum of NHI lies in the financial gap caused by the wide coverage of medical treatment and the high frequency of visiting doctors in Taiwan. We always experience variable healthcare treatments covered by NHI, but that makes the insurance system on the beam of the bankruptcy. The comprehensive range of medication treatments included in NHI, from the flu prescription to the cancer screening, which is rarely seen in other countries. For example, the cost of ambulance transport would be free for patients having urgent needs in Taiwan. Nevertheless, if you have healthcare insurance in Switzerland, no matter under what circumstances, you would have to afford 50% of the ambulance transportation fee (Moneyland.ch, 2018). Moreover, Taiwan’s NHI includes a broad coverage of cancer cares, compared to the only preventive care provided by American health insurance. (Moneyland.ch, 2018). In addition to the inclusion of various medications, Taiwanese’ frequent visits to clinics or hospitals make the financial situation of NHI even worse. The average visit number of seeing a doctor per person annually in Taiwan is about 15.37 in 2019. According to a statistic from OECD (2019), a Dutch goes to see a doctor 8.3 times a year, which is half of ours. Some cases for healthcare treatments are caused by the mindset that I should go to see a doctor because I have paid for NHI, which is actually awful. The ill mindset drives the waste of medications and the expense of NHI. The wide coverage of NHI and the unnecessary visits of physicians cause the financial gap and so we have to fill it by paying more for the insurance system.
The other reason for raising the payment of NHI is due to the inequality of healthcare professionals’ devotion and their salaries. Many people think that a doctor earns plenty of money in Taiwan. But do we understand what is behind this high wage? Based on a report from Central News Agency (CNA, 2019), a physician works 63.5 hours every week at least, and a laborer should only work 40 hours a week according to Labor Standards Act in Taiwan. It demonstrates that doctors’ working hours are much more than usual workers. Furthermore, a doctor's salary is decided by his or her performance valuation. In other words, how much one can gain depends on how many cases one can practice. Therefore, a physician has to diagnose as fast as possible to meet their paying, which results in the sacrifice of the quality of medical services. As a matter of fact, the average income a year for a physician in Taiwan is about USD$84,000 (Ministry of Labor, 2019), and a physician in the USA earns about USD$313,000 annually according to Medscape Physician Compensation Report 2019 (Kane, 2019). But why can increase the payment of NHI benefit doctors? First, it is hard to adjust the working hour system for healthcare professionals. Secondly, due to the rapid growth of the aging population, the number of doctors in Taiwan can’t reach medical demand. Because of these two factors, the only way to improve a healthcare professional’s situation is to increase his or her wage. The income of a hospital lies mostly in the coverage of NHI. Thus, if we pay more for NHI, the incomes for doctors could be boosted to meet their devotion.
Pic2. From Tim Bower
Pic3. From iStockphoto
However, some people may argue that we have already paid a lot for National Health Insurance, which is the ratio of 4.69% of one’s GDP. For example, if one earns NT$24,000 a month, he or she should pay NT$338 for NHI according to the payroll bracket table from National Health Insurance Administration (2019). Yet, it may seem like a noticeable expense when one knows that the average monthly medical expenditure per person in Taiwan is NT$22,168 in 2018 (Directorate-General of Budget, Accounting, and Statistics, Executive Yuan). Our real medical expenses are enormously higher than health insurance payments. What is more, while comparing with other countries’ payments for health insurance, the fee of Taiwan’s NHI is surprisingly low. For instance, the public healthcare insurance premium rate is 7.3% in one’s revenue in Germany (Expatrio, 2020) and 12.9% in Switzerland. Even though these two countries' healthcare insurance ratio is higher than ours, the coverage of the insurance is not as comprehensive as the variety of NHI. For example, the coverage of Germany Public Health Care Insurance, (also named Gesetzliche Krankenversicherung, GKV), doesn’t include dental treatments or further in-patient cares, but a German baker earning 1,626 euro (NT$53,045) per month pays approximately 120 euro (NT$3,915) for GKV, which is 2.5 times higher than Taiwan’s NHI payment with the same monthly wage.
In conclusion, how advanced a country is can be judged by how much it emphasizes on the healthcare system. And a good healthcare system has to be boosted with a well-practiced financial method, which is healthcare insurance. Nonetheless, the low payment of National Health Insurance in Taiwan leads to the financial gap and the insufficient wage for doctors. Because the wide range of medications is covered by NHI, the expense of NHI is hard to be managed. Besides, many citizens would like to see a doctor in a clinic when the illness is so light, which results in the wasteful cost of medical treatments. Due to the long working hours of a doctor, he or she should be rewarded by an equivalent salary just like a physician in other developed countries. To solve the two main issues I mentioned above, we must increase our payment of National Health Insurance.