Series on medical tourism destination: Taiwan Health System


Taiwan's Health system organization and National Health Insurance (NHI)

Taiwan is an island country located in Eastern Part of Asia near China. It is a developed country with GDP of US 20,958 per capita in 2014. The National Health Insurance (NHI) in Taiwan has been launched since March 1995 due to public pressure. Prior to implementation of NHI, health services were payed out of pocket and through various insurance groups. The NHI combined all this insurance groups into a single payer, the population to a single client and the health services as multiple providers (Gui, 2014). This system has resulted in affordable and quality health care to its population at a low administrative cost and with a high satisfaction rate by the population. According to the satisfaction surveys (Liao, Chang & Sun, 2012; Chiao, Ksobiech & Wei, 2014), more than 80% of the respondents are satisfied in terms of medical services, quality of care, or the extensive use of information technology. THS has also a good rating by the expatriates living in Taiwan[1]. In 2005, the Nobel Laureate Paul Krugman praised Taiwan’s health care system that had expanded coverage without a major increase in health expenditures (Ho, 2015). Now, the NHI system covers 99.9% of the population and 93% of the hospitals and clinics that provides extremely convenient and high quality but cheaper health care for the residents (Cheng, 2015a).

Healthcare System and Quality in Taiwan

In Taiwan, all hospitals are given accreditation by the Taiwan Joint Commission on Medical Accreditation (TJCHA). This organization helps in maintaining doctor standards and assuring medical and health care quality in the hospitals. In Taiwanese hospitals, the standard of healthcare services is maintained quite high in order to receive higher accreditation. If the accreditation standards are high, then more subsidies will be received for that particular hospital and its concerned facilities. This helps to ensure that a particular standard of healthcare providers is maintained throughout the country.

Advantages of receiving medical care in Taiwan

Taiwan has many advantages when it comes to getting health care services (Ho Chan, 2010). Many reports point out these advantages[2] such as: low-cost but high quality treatment, highly qualified medical professionals, diversified treatment plans alongside with excellent follow-up programs, use of highly up-to-date and sophisticated technology, whole department dedicated for international patient, numerous international available flights to travel, visitor-friendly environment.

Taiwan healthcare providers’ services weakness

Even though THS is largely opened to serve expatriates, there is a difference between the Hospitals in big cities and those in small towns in regard to their abilities to serve foreign residents who don’t speak Chinese and the most common local language (Taiwanese dialect). To recognize those hospitals who can serve international aliens, we need to check if they receive a JCI- accreditation from the Joint Commission International whose parent institution is in the US. Now no more than twelve Taiwanese hospitals received the JCI accreditation (Gilhawley, 2015).  

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[2] Several advantages about Taiwan Healthcare system have been mentioned, but here are presented the most relevant ones summarized from various sources  available online: (a) https://www.medicaltourismindex.com/destination/taiwan/; (b) http://www.medicaltourismassociation.com/en/research-and-surveys.html


Innovative biotechnology industry and biopharmaceutical advances in Taiwan




Realizing the lack of natural resources (such as petroleum or other valuable minerals) in the island, early Taiwanese governments have defined clear economic strategies that would help the country to flourish. A special consideration was given to the sector of services to strengthen the local economy. According to 2009 data by Taiwan Statistical Bureau (eng.stat.gov.tw ), the service sector (finance, real estate, commerce, telecommunication, etc.) contributed the biggest slice of GDP at 69.2 percent, with industry accounting for 29.2 percent, and agriculture 1.8 percent. These changes have begun since early 1980s when Taiwan's government shifted the focus of its economic strategy from Labor-intensive production (processed foods, wood and bamboo products) to capital-and technology-intensive industrialization (Chei-Hsiang Chen, 2007). By now, more than a quarter of national workforce is employed in the electronics and high-tech manufacturing sector, only. As of 2016, manufacturing sector represents up to 30 percent of GDP among various other economic categories such as agriculture, construction, electricity, trade, transport, public administration, finance and real estate (eng.stat.gov.tw).

In 2016, the Taiwanese government has launched a new industrial development policy consisting to promote the development of "Five Innovative Industries": (1) Smart machinery, (2) Asian Silicon Valley, (3) Green energy, (4) National defense, (5) Biotechnology & pharmaceutical industry (IDB MOE, 2017). About the latest category, Taiwan has become one of the top leaders worldwide in the field of biotechnology and has ambitious aim to shine internationally. According to the Development Center for Biotechnology (an initiative of Taiwan government, dcb.org.tw), biotechnology industry encompasses three main sub-sectors: applied biotechnology (agriculture and environment), medical devices (electronics) and pharmaceuticals. As Taiwan High-tech continues to grow, new incentives have been given to biopharma firms to boost both innovation and new products development. Taiwan’s biotech firms include Taimed, Medigen, TaiGen, TopoGenomics, TTY Biopharma in addition to many others with a combined market cap of US$23 billion. Taiwan currently has 96 drugs in the development pipeline, over half of them in Stage 2 clinical trials. Up to October 2016, for the studies listed in the US-managed website- clinicaltrials.gov, Taiwan was in first position (1537 trials) before Korea (1455), China (1372), Japan (1305) and India (1115), respectively in this descending order (Shang-Pwu Shia, 2016).   

Innovative and ambitious approaches that were implemented by the Taiwanese giant biotech corporation, Medigen Vaccine Biologics Co, hope to be soon rewarding. If the vaccine being researched by Medigen for the dreadful dengue fever infection is successfully formulated, Taiwan will be known as the home of a major medical contribution that helps to protect around 4 billion people worldwide exposed to the threat of this disease, according to a news report by Sophia Yeh and Evelyn Kao, 2016. For sure, that will be also a boost for the biotech versus biopharma industry in Taiwan. And more importantly, this vaccine will counteract the life threaten risk of the victims by the virus and alleviate the social economic burden faced by affected families. Recently, a Filipina worker whom I know in Taichung, has reported the sudden death of her seven-year-old nice in the Philippines, due to Japanese dengue infection. This paper is a mean that I use to share my condolences with the family. There is hope, only and only if new vaccines are successfully developed. Good luck to Medigen!

Reference:
1- IDB MOEA (2016 October). 2017 Introduction to Biotechnology and Pharmaceutical industries Industries in Taiwan, Republic of China. ISBN: 978-986-05-0005-9.
2- Yeh, S. & Kao, E. (2016, October 26). Taiwan striving to boost biotech industry growth: vice president. Retrieved from http://focustaiwan.tw/news/ast/201610260018.aspx
3- Shia, S. P. (2016, October 28). Biotech Industry in Taiwan. Retrieved from http://www.nccu.edu.tw/

4- Chen, C.H. (2007). Taiwan Biotech and the Pharmaceutical Industries. APBN, 11, 835