Thursday, April 15, 2010

Taiwan's Awesome Health Care System

My wife just finished a round of surgery. The problem was serious, but it appears to be taken care of.

We are grateful beyond words for Taiwan's incredible health care system. Here in Taiwan the cost of this complex care for my wife appears unlikely to exceed several hundred US dollars for surgery, pre-surgery tests, and ten days of post-surgical care. A third of that charge is a $6000 NT charge for the morphine drip (I got the expensive version) which the patient must pay for. Heaven knows what would have happened had we faced this problem in the crapshoot that Americans call a health insurance system.

I can't say enough good things about everyone involved -- the nurses were great, the doc totally professional and talented -- and caring, he works 14 hour days yet still spends the time to talk with each patient. We did spend months prior with misdiagnoses, but that occurs in all systems. I don't really think it is a doctor issue so much as a specialist issue; misdiagnoses are common in all professions. The difference is that when a car mechanic or a computer repairman misdiagnoses your car or computer, it doesn't scream at you in pain or wake up in the middle of the night bleeding all over the sheets.

An interesting wrinkle we discovered is that when you have a serious illness the government gives you a special health insurance card, the Serious illness Card, which means that you get lower health fees forever after. Shouldn't we have to pay slightly more, to help amortize system costs? No wonder the system is suffering funding problems.

In Taiwan patients' families must stay with them in the hospital to help out with the care. This saves the NHI a bundle of money on patient care, since fewer nurses, assistants, and volunteers are required as a result. A whole system has evolved for this. In the hospital we stayed at the chairs in each ward folded out to become beds for family members, and the nurses are used to cooperating. If the patient has no family available, there are people who hang out around the hospital and hire themselves out as patient caregivers. So my kids and I took turns sleeping at the hospital to care for my wife.

I was here in Taiwan before this system was implemented. After using it for more than a decade, all I can say is that single payer is the only rational choice.
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Anonymous said...

Judging from the picture I can only tell it was a serious illness by the I.V. drip. She looks great.

Robert R. said...

...the Serious illness Card, which means that you get lower health fees forever after. Shouldn't we have to pay slightly more, to help amortize system costs? No wonder the system is suffering funding problems.

Well, the goal is to reduce the financial burden on the seriously ill, especially key since they are less able to get income to pay higher fees.

Funding problems can, of course, be solved by gathering money from a wide choice of sources, but IMHO, I pay far too little in premiums given my income.
While a "tax the rich" only goes so far, every step counts.

Dwight said...

I hope she enjoys a speedy and complete recovery.

I second that emotion on the Taiwan health care system. Unfortunately, my brother-in-law was recently diagnosed with the type of brain cancer that took Ted Kennedy. He's had surgery and has now been through the first round of chemo and radiation. Fingers crossed. It's shocking to think what his situation would be in the US. The situation for the whole family, really.

Anonymous said...

Mikey, happy to know that your wife is ok now.


P. S. said...

She is smiling, which says a lot. Thanks for sharing, and for pointing out some interesting aspects of patient care. Wishing her the best of luck recovering.

STOP Ma said...

Great to hear that your wife was treated well, Michael! And single-payer (or Universal Health Care, as it's called in Canada), is definitely the best option.

However, I have several personal horror stories about the hospitals in Taiwan that will tarnish my opinion of this country's health care system for a long long time.

Islander said...

Michael- I follow your blog everyday and am grateful you're still blogging away. I'm glad your wife is doing well from surgery. Best wishes to your family.

SY said...

I once had a discussion with a clinician about the possibility of making the Serious Illness Card only available to affected low income families. He told me that it may not save the system much money because of the additional administrative costs (e.g. annual review for renewal and fraud-check.) As Robert R wrote, the system simply assumes that a seriously ill person would be financially affected.

He (an NTU prof) told me that the practice gives the affected patient and family the humane assurance that the whole society cares about her/him. It has positive effects on the patient's overall health, which in a way also saves the system money.

BTW, I envy very much that the Taiwanese health care system also covers care by Han Medicine and the prescribed herbal remedy.

I wish your wife a speedy recovery.

竹板凳 said...

The biggest issue with Taiwan's health care system is that the rates for some reason is tied to the political systems. Therefore parties in power are reluctant to raise cost for the past 10 years.

The fact that KMT cities and counties feels like they can collect the health care fees and not turn them in is a pretty retarded problem that is only happening because the voters let them get away with it.

I hear a lot of complaints from the wealthy saying they feel like they are getting charged too much, therefore they evade the fees by changing to receive their incomes in China. Yet these wealthy people do not need to live or work in China, and still uses the system like everyone else. it's a very sad fact.

The system itself is perfect. The people around it needs some adjustments... but i guess that happens to any nation with any kind of government. At least in a democracy, there's hope for things to improve.

Anonymous said...

Shouldn't we have to pay slightly more, to help amortize system costs? No wonder the system is suffering funding problems.

It's hard for Taiwan's health care system not to suffer after Ma Ying-jeou instructed Taipei City government to swallow the Health Care fee of 70,000,000,000 dollars (more than 2 billion US dollars) that he was supposed to turn in to central government when he was Taipei Mayor.

This issue has been discussed, but oddly, no one seems to ask how Ma Ying-jeou used, or if he pocketed, that huge amount of money.

It's a weird phenomena in Taiwan's politics --- No one seems to care where the money goes.

Taipei District Court is now asking Chen SB and his family to turn the overseas deposits back to "court-assigned account" in Taiwan (in return of a "maybe we will consider his release on bail").

Chen SB's money doesn't belong to the state or the court, but are donations from pan-green supporters.

Again, no one, not even the green camp, asks to have those $ return to the green camp.

People just let Ma Ying-jeou and his cohorts take away their money right in front of them.

Is it a cultural thing ? That Taiwanese feel shameful to ask for their own money once the money is not in their hands ?

(Sry, out of topics ...)

Michael Turton said...

Anon, excellent comment. I need to write a whole post on that.

Anonymous said...

Just curious, how is Taiwan's health care made affordable? By a very efficient process of using cost-effective technology and means? Or with a relatively high governmental budget from the taxes?

Todd said...

Glad to hear your wife is ok!

Thomas said...

In general, I was very pleased with the health care system when I was in Taiwan, although I thankfully never had to go through a serious medical procedure.

Incidentally, health care is one of those topics that should interest me more but always turns me off. This is because providing high-quality, low-cost care is impossible unless some or all of the parties involved are willing to allow policies made that are not in their immediate financial interests. And we all know how often that happens.

I am glad that it worked out well for your wife in the end and that you feel that life can get back to normal soon.

Michael Turton said...


Health care in Taiwan is affordable because (1) the government implements some cost controls (2) the administrative efficiency of the system here is the world's best -- admin costs run 2% vs 20% in the bloated, inefficient, uncompetitive private US firms. Taxes here are lower than in the US, and there is no capital gains tax.

Of course, Taiwan doesn't spend three-fourths of the discretionary budget on its military. Americans pay zillions in taxes for the privilege of killing Afghans and Iraqis; Taiwanese, for the privilege of caring for each other.


Beijing2008 said...

@ Michael: I'd be far more inclined to think that America's problem is spending too much on welfare, Social Security, Medicare, and Medicaid (which, all combined, total for 53% of the entire U.S. government budget.)

Spending on the U.S. military only accounts for 21% of the American governmental budget.

Robert Scott Kelly said...

Good to hear the op was a success. Best to you and the wife.

Michael Turton said...

Social security spending is non-discretionary. Of discretionary spending, the costs of empire eat the majority. From

The total Discretionary spending in FY 2006 was $1.017 trillion, which is 38% of total Federal budget spending. Of this, over half is what OMB calls Security-related spending. This is spending for the Department of Defense, Homeland Security and the War on Terror.

The rest is non-security spending. The largest departments are Health and Human Services, Education, Veterans Administration and the State Department. These four agencies spend over half of the non-Security budget.

Note that the non-security spending includes Veterans Administration -- military spending -- and State Department -- spending on empire. The $16 billion State Department budget is $1.7B for Iraq, and another $1.1 for security. The costs of empire are spread around the budget to hide its immense size.


TicoExpat said...

Hope she makes a speedy recovery.

I think it is wonderful to be able to have your family there when you are sick. It shows appreciation that a serious illness affects them as a whole.

Best wishes.

Michael Turton said...

Thanks Tico!

Geoff said...

Ming and I wish your wife a rapid and complete recovery. It is reassuring to have that NHS umbrella when things go wrong. How are you and the kids coping domestically? Cheers, Geoff

Beijing2008 said...

This past December, I was able to get an upper endoscopy, an executive physical exam, several dental fillings and a root canal done in Taiwan.

The whole process cost $2,000 US - if one includes airfare, it was nearly $4,000 US in total.

I was informed by Internet sources that the same procedures would have cost me at least $9,000 in total in the States!

Michael Turton said...

My wife is home and the bill is in: $17,120 NT. About $500 US. Amazing. Lots of medical tourism in Taiwan's future!

Beijing2008 said...

I don't know if you posted this or not, but it's worth posting:

And perhaps one reason for low-cost health care is that you can't sue a doctor frivolously the same way you can in the States.

Andrei said...

Thanks for the info. I was planning to go to Taiwan to look for an esl job but then was diagnosed with 2 pretty nasty chronic illnesses and this post makes me see things a bit more optimistically. I wanted to ask you - are a lot of western medications available in Taiwan? If you get a work visa, are you automatically put on the government plan? Thanks in advance for any input.