The WHO's World Health Report 2008: Primary Health Care: Now More Than Ever recognizes three dimensions of UHC:
- breadth of coverage: aims to provide access to health services to all people;
- depth of coverage: aims to provide more health services at low or no cost;
- height of coverage: governments should subsidize the health system with funding sources, such as taxes and health insurance, to minimize co-payments for medical care.
In the World Health Report 2010 on “Health Systems Financing: The path to universal coverage,” it states that Member States, in establishing their health systems, should adhere to the three dimensions, and ought to consider their financial scale and actual needs to build an appropriate, sustainable, and financially sound health system policy.
Taiwan's NHI has continually endeavored to adhere to the three dimensions; results of which are below:
- breadth of coverage
All people with Taiwan nationality, people who have had a registered household for 6 months or more in Taiwan, and infants who were born in Taiwan must participate in NHI. After multiple amendments to laws, the NHI has gradually expanded its coverage to include new immigrants, long-term alien residents, overseas Chinese students and foreign students, and military. Statistics indicate that there were 23,869,984 people participating in NHI as of August 2022, and all of the residents have been covered.
- depth of coverage
The medical services currently provided by the NHI include outpatient care, inpatient care, traditional Chinese medicine, dental care, child delivery, physiotherapy and rehabilitation, home health care, chronic mental illness rehabilitation, and etc. The scope of medical payments includes diagnosis, examination, lab tests, consultation, surgery, anesthesia, medication, materials, treatment, nursing, and insured beds; essentially all necessary health care services are covered by the system.
As of the end of August 2022, NHI contracted hospitals and clinics totaled 21,751, and accounted for 92.10% of all hospitals and clinics in Taiwan. There were also 7,069 contracted pharmacies, 741 home nursing care institutions, 248 psychiatric rehabilitation centers, 17 midwifery institutions, 216 medical examination clinics, 31 physical therapy clinics, 10 medical radiation clinics, 2 occupational therapy clinics, and 4 home respiratory care units. Insureds may freely choose at which hospital or clinic they will receive medical services.
- height of coverage
To ensure balanced medical development and provide the public with up-to-date medical technologies, the NHIA has continued to add new treatment items reflecting technological progress and real clinical needs. As of December 2021, the fee schedule covered a total of 4,711 treatment items. The adjustment of the fee schedule was announced 109 times between 2004 and December 2021, and revisions were made to payment points for 3,088 treatment items.
It is of utmost importance to establish a sustainable health financing system to achieve the purpose of UHC—to provide the people with necessary health services to the extent to which that is possible, and to ensure that people are not impoverished due to illness. The NHI system has been in operation for more than a quarter of a century, and has undergone several adjustments to meet changes in Taiwan’s society as well as the expectations of the people.