Peabody JW, Yu JC, Wang YR, Bickel SR.

AHSR FHSR Annu Meet Abstr Book. 1994; 11: 47.

Veteran's Administration, Department of Medicine, West Los Angeles and RAND Corporation, Santa Monica, CA 90407.

PROBLEM AND OBJECTIVE: As we debate health care reform in the United States, international comparisons are useful because they provide data on how certain health care policies have worked in other countries. The Republic of China or Taiwan provides an interesting comparison because of its similarities with the U.S. health care system. DATA AND METHODS: Obtaining data from government documents, providers, government officials, published articles and government statistics, we conducted a descriptive case study of Taiwan's health care system during the last two decades. We explored problems that Taiwan has experienced with regard to policy implementation, access, insurance coverage, cost control and limited competition in the health care sector. RESULTS AND CONCLUSIONS: Three large insurance programs jointly financed by employers, employees and the government now cover 54% of the population. However, many underprivileged groups are not covered by these programs, notably children and the elderly. Health care expenditures in Taiwan have recently accelerated, growing at an annual rate of 23% between 1990 and 1993. Cost control measures, therefore, have not been very successful. Control of hospital charges has been impeded by lack of a good cost accounting system for hospitals in Taiwan. Physicians have responded to controls on physician fees by shortening their physician visits, increasing the volume of visits, and prescribing large amounts of prescription drugs. Despite accelerating health care costs, Taiwan has already decided to go ahead with plans to provide universal insurance coverage. Officials in Taiwan remain concerned that rising health care costs could undermine the viability of universal coverage. This decision probably reflects Taiwan's social values of "equity" or "distributional justice". IMPLICATIONS FOR AUDIENCE: Important observations and lessons from the Taiwan experience include: 1) Expanded insurance coverage does not, by itself, improve the distribution of health care to underserved areas; 2) Regulation, in a fee-for-service system, has not been effective in controlling costs and may result in volume increases, and 3) User accountability is compatible with a program of universal coverage.

Publication Types:

• Meeting Abstracts

Keywords:

• Aged
• Child
• China
• Cost Control
• Delivery of Health Care
• Fee-for-Service Plans
• Health Care Costs
• Health Care Reform
• Health Expenditures
• Health Policy
• Humans
• Taiwan
• United States
• Universal Coverage
• economics
• hsrmtgs

Other ID:

• HTX/94910881

UI: 102212029

From Meeting Abstracts