I never thought that I would spend so much time worrying
about health insurance, doctor visit copays, and dental coverage – a sure sign
of getting older. Now that Jess and I
have a little guy to watch out for, quality healthcare is extremely important
to us. In fact, affordable access to
healthcare is one of the reasons why I am writing this blog post from
Taiwan. If we were to “downshift” in the
US by having one of us stay home with Abel and the other teach full time, the working
spouse would have to pay $650 per month
to cover the health insurance premiums for the family. As a public school teacher, that is a huge
expense which makes it nearly impossible to spend a year at home with a
baby. Luckily, Taiwan has a much more
efficient and affordable healthcare system that even welcomes foreigners!
We had an up close and personal experience with healthcare
in Taiwan just the other day when we took Abel in for his four month
immunizations. We have spent countless
hours researching online, emailing with family doctors, and we even met with a
travel health doctor while in Austin. We
were very nervous about the whole process, but we were happy to learn that our
worries were unfounded. I won’t say it
was a pleasant experience, I doubt giving shots to a baby can ever be anything
but miserable, but I did marvel at the efficiency of the clinic and its staff.
The contrast between pleasantness and efficiency pretty well
sums up one of the most interesting aspects of healthcare in Taiwan – not terribly
pleasant, but extremely efficient. The unpleasantness
does not come from substandard care or unfriendly staff, but from is a byproduct
of the system which does not sacrifice one iota of efficiency for the sake of
privacy. My other experience with the
Taiwanese healthcare system was when I had to get a “health check” at the city
hospital so that I could apply for the resident certificate. During this check, I had blood drawn at a
counter with 20 people lined up behind me, changed into a hospital robe and
waited in line for my number to be called, and had a chest extra in front of 20
other strangers after they announced my name over the intercom. No HIPA (Health Information Privacy Act) here
in Taiwan. My chart containing test
results and other sensitive information was passed around to volunteers and
left on counters. Of course I had
nothing to hide, but it is very different than the extreme privacy afforded at
US hospitals.
Privacy may not be paramount in Taiwan, but equitable access
to quality healthcare certainly is a top priority. Every citizen, and even alien residents like
us, is provided with free health coverage. The system is similar to Medicare,
but expanded to the entire population.
Working folks pay a tax similar to Medicare tax that is a percentage of
income, and there are small copays for visits, usually just a few dollars. The poor, elderly, and veterans are all
covered for free.
What makes this equitable access to care possible? Efficiency.
Taiwan does more with less by cutting administrative costs and streamlining
care delivery with the single payer system.
Also, record keeping and billing are extremely streamlined due to the
health care card that is embedded with a smart chip that contains a summary of health
information and records. These
streamlined measures help to make the Taiwanese system one of the most
affordable and efficient in the world. While the US spends 15% of its GDP on
health care, Taiwan spends only 6%. That
means that the average amount spent per person per year in the US on healthcare
is $7000, but only $2000 in Taiwan. That
is an enormous difference considering that there is very little difference in
quality.
The amazing part is that people access healthcare services
more often in Taiwan than in the US. “Health
seeking behaviors” are very high in Taiwan and people go to clinics, Chinese
medical offices, acupuncturists, and massage therapists for even minor
ailments. And it is all covered! It seems
to me that if you make healthcare affordable, then people will seek medical
help for minor ailments before they become more severe, which will save
everyone a lot of money in the long run.
Financial barriers to healthcare cause people in the US to put off going
to the doctor, which leads to more chronic illnesses and acute conditions that
require expensive and invasive procedures after they become more serious, which
is part of the reason why the US has the highest per capital healthcare costs
in the world.
If the whole purpose of healthcare is to help us live longer
healthier lives, then Taiwan is getting a lot of bang for their buck – the
average Taiwanese lives over a year longer than the average American. We spend
over three times as much and don’t live as long. The Taiwanese studied our Medicare system to
find inspiration for their healthcare system, now maybe it is time that we study
Taiwan’s National Health Insurance system to find ways to improve the health of
our country.
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