It is now two decades since Taiwan’s National Health Insurance (NHI) system was first launched in 1995 to provide a safety net for the health of Taiwan’s citizens. Responding to changes in people’s healthcare needs and advances in medical technology, the Ministry of Health and Welfare and the National Health Insurance Administration have undertaken ongoing innovation, including the Second-generation NHI scheme that was launched in 2013 with the aim of providing healthcare services that are more closely tailored to people’s real needs. These efforts have won widespread praise both in Taiwan and in the wider international community. They have been extensively reported on in the international media, and Professor Paul Krugman (winner of the Nobel Prize in Economics) has expressed approval of the way that Taiwan’s NHI system has succeeded in providing universal coverage for all of Taiwan’s people without a significant increase in overall healthcare costs. In recent years, the percentage of Taiwan’s citizens who express satisfaction with the NHI system has consistently hovered around 80%. Overall, the NHI system can fairly be said to be one of Taiwan’s most impressive achievements.

Taiwan has worked constantly to achieve innovative breakthroughs in the NHI system in order to keep pace with citizens’ expectations and with global trends in healthcare service provision. This year, to mark the 20th anniversary of the establishment of the NHI system, the National Health Insurance Administration organized the holding of a Taiwan’s NHI 20th Anniversary Symposium and Round Table on March 16 – 17, 2015 at the Howard Civil Service International House in Taipei. Leading academics and other experts from around the world were invited to attend the event, with a total of more than 100 attendees from 23 different countries, including the U.S., Canada, the U.K., Germany, Japan, South Korea, Thailand, the Philippines, Ghana, South Africa, China (including Hong Kong), Malaysia, Saõ Tomé and Príncipe, Panama, Swaziland, Tuvalu, Nicaragua, the Marshall Islands, Nauru, Burkina Faso, Saint Kitts and Nevis, Australia, Mexico, and Nigeria, as well as over 900 NHI experts, healthcare professionals and representatives of related industry sectors from Taiwan.

President Ma Ying-jeou attended the Symposium, where he gave an address praising the achievements of Taiwan’s NHI system, and of the protection and peace of mind that the NHI system has provided for Taiwan’s citizens. President Ma also noted that Taiwan’s extension of NHI coverage to include the prison population was a demonstration of respect for basic human rights that had won Taiwan widespread plaudits among the advanced nations. Control Yuan President Chang Po-ya shared her memories of participating in the setting up of Taiwan’s NHI system when she was serving as Minister of Health in the 1990s, and expressed the hope that, in the future, the NHI system would be able to meet the needs of every Taiwan citizen even more effectively than at present, paying particular attention to the growing demand for long-term care for senior citizens. The Symposium was also attended by a number of leading Taiwanese academics who have made important contributions to the formulation of NHI policy, including Dr. Yeh Chin-ch’uan, Dr. Yang Chih-liang, Dr. Cheng Shou-hsia, Dr. Lai Mei-shu, Dr. Chang Hung-jen, Dr. Lee Yu-ch’un, and Dr. Lu Jui-fen. Also attending the Symposium to demonstrate their support for Taiwan’s NHI system were: Dr. Seong Sang-cheol, Chairman of South Korea’s National Health Insurance Service (NHIS), which has collaborated closely with Taiwan’s NHI system over the years; Dr. Alexander A. Padilla, President and CEO of the Philippine Health Insurance Corporation (PhilHealth); Dr. Winai Sawasdivorn, Secretary General of Thailand’s National Health Security Office (NHSO), and a number of other distinguished foreign guests. Taiwan’s NHI system has benefited from the involvement of academics and other experts at the planning stage, from the support of the general public during the implementation of the new system, and from the hard work and commitment of medical professionals, which together have enabled the NHI system to put down strong roots and maintain steady growth over a period of two decades, receiving a high degree of international recognition.

Despite the solid foundations that have already been laid by Taiwan’s NHI system, there are still many challenges to be faced. The National Health Insurance Administration hopes that the holding of this Symposium and Round Table will provide a platform for international exchange, so that those advanced nations that already possess highly-developed national health insurance systems can share their ideas regarding global trends in health policy, and so that Taiwan can share its experience in NHI system development with developing nations that are currently in the process of development their own national health insurance systems. The Symposium and Round Table symbolizes the “borderless” nature of healthcare. With experts from different countries coming together to share their wisdom, working together to consider how improvements can be made to invigorate national health insurance systems around the world, the Symposium and Round Table has opened up a window for the effective sharing of experience and ideas.

The planning of the Symposium and Round Table benefited from the assistance provided by Dr. William C. Hsiao of Harvard University, who has for many years been actively involved in supporting Taiwan’s NHI system. Dr. Hsiao served as an Advisor on the original NHI system planning team, and played an important role in the first-stage planning for the establishment of the NHI system. It is therefore a great honor to have had Dr. Hsiao assist with the planning for this Symposium and Round Table, 20 years after the NHI system was first established. The Symposium and Round Table was held over two days, with four keynote speeches on March 16. Professor Uwe Reinhardt, a health economist at Princeton University, spoke on the topic of “Trends in Health System Reforms among OECD Nations.” Dr. Reinhardt is a leading health economist who has also served as an Advisor to Taiwan’s Science & Technology Advisory Group of the Executive Yuan, and has for many years been providing important recommendations regarding health economics policy development in Taiwan. In his keynote speech, Dr. Reinhardt provided a succinct analysis of important recent trends in healthcare reform in the advanced nations of Europe, which can serve as a reference for Taiwan as it seeks to implement healthcare reforms in the future. Professor Sherry Glied of New York University discussed “Taiwan’s NHI System in a Comparative Context.” Dr. Glied is an expert on health policy reform and mental health care policy; she is currently serving as Dean of the Robert F. Wagner School of Public Service at New York University. In her keynote speech, Dr. Glied used international comparisons to provide an in-depth analysis of Taiwan’s NHI system, suggesting ways in which the system can be brought into line with global best practice. The final keynote speech of the day was given by Professor Chris Ham, CEO of the King’s Fund in the U.K., who spoke on the topic of the “World Trend toward Integrated Delivery Systems with Gatekeepers.” The King’s Fund is one of the U.K.’s leading think-tanks, and is closely involved with healthcare provision in the U.K.; Dr. Ham previously served as Professor of Health Policy and Management at the University of Birmingham. In his keynote speech, Dr. Ham gave an easy-to-understand description of the general practitioner (family doctor) system, a system which Taiwan is currently working to develop; Dr. Ham’s address has thus made a useful contribution towards the ongoing development of Taiwan’s healthcare system. Also during the first day, Dr. Huang San-kuei, the Director-General of the National Health Insurance Administration (NHIA), gave an address on the topic of “Taiwan’s NHI System – Achievements & Challenges,” in which he noted the establishment of the “My Health Bank” platform as a starting point for the provision of personalized healthcare information to Taiwan’s citizens, providing an important tool for self-directed health management. Dr. Huang said that, in the future, Taiwan would be working to bring about closer collaboration between the healthcare sector and the IT services industry, so as to bring about an across-the-board strengthening of healthcare provision for Taiwan’s citizens, and stimulate the development of related industries. The event continued on March 17th with the holding of a Round Table discussion, at which four sub-topics were discussed: Financial Sustainability, Payment System Reform, Efficiency & Effectiveness, and Quality of Healthcare. It is anticipated that the practically-oriented, in-depth, focused discussion during this Round Table will have contributed to the development of operational mechanisms for stabilizing NHI finances, to the development of payment systems that allow resources to be allocated with maximum efficiency, to the formulation of strategies for enhancing the effectiveness of care provision, and to the identification of concrete methods for boosting the overall quality of medical treatment, thereby paving the way for the ongoing reform of Taiwan’s NHI system and opening up new perspectives.

Outside the conference hall, there was a display entitled “Looking Back over Two Decades of NHI System Development,” which outlined how the NHI system has developed in the context of the other changes that have taken place in Taiwan over this period. The display also showcased the “My Health Bank” system and “PharmaCloud System” that have recently been developed by the NHIA. These two systems make it possible for medical professionals and ordinary citizens to access their personal medical records whenever they need them, thereby enhancing citizens’ ability to implement self-care, and enhancing the overall safety and quality of medical treatment. The display helped to give viewers a better understanding of the key milestones in the development of the NHI system in Taiwan, and of the vision for integrating future NHI development with modern information technology. Overall, the display symbolized the way in which, during the two decades that have elapsed since the NHI system was first established, there has been an ongoing effort to acquire new knowledge, accompanied by ongoing, continuous innovation, and a vigorous commitment to sustainable development of the NHI system.

The Taiwan’s NHI 20th Anniversary Symposium and Round Table provided a marvelous venue for the exchange of experience and ideas between countries, and exposed participants to new perspectives and new ideas. The impressive results achieved at the Symposium and Round Table will help to guide the NHIA as it strives for new breakthroughs and continued innovation in the future, helping to gradually realize the goal of enabling Taiwan’s citizens to live longer, better, healthier lives while providing healthcare in a sustainable manner, and laying the foundations for a further 20 glorious years of successful NHI system operation.