Department of Health Care Management, College of Management, Chang Gung University, Taiwan.
Health Econ Policy Law. 2011 Jan;6(1):85-107. doi: 10.1017/S1744133109990351. Epub 2010 Mar 4.
This study aims to present an overview of the evolutionary policy process in reforming the health care system in Taiwan, through dissecting the forces of knowledge, social-cultural context, economic resources and political system. We further identify factors, which had a significant impact on health care reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI) program in 1995, after nearly five years of planning efforts (1988-1993) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, health care reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwan's health care system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different health care systems around the world, Taiwan's experiences in reforming its health care system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition.
本研究旨在通过剖析知识力量、社会文化背景、经济资源和政治制度，呈现台湾医疗保健制度改革的演进政策过程概述。我们进一步通过说明性政策实例，确定对台湾医疗改革政策有重大影响的因素。其中一个最具启发性的实例是，在经历了近五年的规划努力（1988-1993 年）和两年的立法马拉松后，1995 年成功设计和实施了单一支付者全民健康保险（NHI）计划。NHI 是台湾历史上实施的最受欢迎的社会项目之一，大大增强了对意外医疗费用的财务保障，并确保了获得医疗服务的机会。然而，医疗保健改革仍有未完的议程。尽管满意度评分很高，但由于人口迅速老龄化、经济停滞和 NHI 收支不平衡，台湾的医疗保健系统今天面临着新改革的压力。尽管世界上不同的医疗保健系统可能存在一些异构的系统特征和挑战，但台湾在过去几十年改革其医疗保健系统的经验可能为正在经历快速经济和政治转型的国家提供宝贵的经验教训。
