Taiwan: Leader in Universal Healthcare Access

this after making the first steps toward single payer in 1995

http://www.wma.net/en/45blogs/2012_pblog12/index.html

Health care expenditures at 6.4 per cent of GDP are low compared with other OECD countries, but Taiwan shares with other countries the experience of an increase in health care expenditures (5.1 per cent) that exceeds the growth of the economy. Feeding this is medical utilization of 14.9 outpatient visits per person and hospital admissions of 14 per 100 persons per year. Currently expenditures under NHI exceed revenues.

To deal with the challenge of rapidly increasing costs the payment system has evolved since 1995 from initially fee-for-service with case payment to the addition of global budgets, pay for performance (P4P), diagnosis related groups (DRG), resource based relative value system (RBRVS) and capitation programs.

Last year the government passed the amended National Health Insurance Act. The act has as its purpose "endeavoring to better respond to the demands of the population and to better accommodate the practical requirements of the program".

Highlights of this "Second Generation NHI" include:

--Imposing supplementary premiums based on sources of income
--Establishing a mechanism linking revenues with expenditures by consolidating current decision-making bodies
--Diversifying payment schemes to providers
--Public disclosure of important information on decision making meetings, medical care quality, serious rule violators and financial data
--Healthcare systems are deeply rooted in each country's cultural ideas about society and values. Whether one model works for a particular country depends on its goals and values. In other words there is no evidence that one model is better than another, if you do not define what you want to achieve and whom you are willing to trust.