Learning from Taiwan: Experience with Universal Health Insurance

As the 2008 presidential election renews the debate about health insurance coverage, the United States can learn from the experience of countries that have recently moved to achieve universal coverage. What gains can we expect from coverage for all in improved health, better access to health care, and reduced financial burdens for the most vulnerable patients? What are the potential downsides of a single-payer system of health care financing?

In this issue, Wen and colleagues (1) provide insights into these questions. Their analysis of trends in life expectancy before and after the introduction of national health insurance in Taiwan in 1995 suggests a substantial payoff for investing in health insurance for all, but it also indicates the importance of a broad, systemic approach to health reform.

Since 1995, when Taiwan implemented universal national health insurance legislation, coverage has increased from 57% to 98% of the population. National health insurance added coverage for children, elderly persons, and nonworking adults. In addition, copayments (10% for inpatient and 20% for outpatient care) were waived for the very poor, veterans, and aborigines. To examine the contribution of universal coverage to improved health, Wen and colleagues (1) compared trends in life expectancy for the decade before the introduction of national health insurance (1982–1984 to 1992–1994) with the decade after (1992–1994 to 2002–2004). Life expectancy for men improved 2.39 years during the decade after national health insurance, which does not differ statistically from the gain of 2.27 years during the decade before national health insurance. Similarly, life expectancy for women improved 0.05 year more in the period after national health insurance was introduced than in the period before. These overall results, however, may not be sensitive to changes caused by national health insurance, because more than half of the population was covered in the period before …