Harvard research fellow lectures at Rutgers-Camden

Steve Rayesky | Staff Writer

A lecture on the single-payer health care model was given on Tuesday by Professor Michael S. Chen, a research fellow with Harvard University’s School of Public Health.
Chen gave a presentation entitled “Working Toward Sustainable Universal National Health Insurance,” in which he outlined Taiwan’s National Health Insurance. NHI is the universal health care program that began in 1995 and is a compulsory system that is operated by the government. Chen designed the program and serves as Senior Advisor.
Chen outlined the main elements of the system, how it has served the Taiwan over the past 17 years, and how it continues to change and evolve.
For starters, a single-payer system refers to who is paying the medical bill, and in this case, it is the government who covers all medical expenses of its citizens. Unlike the U.S., which has public and private providers, Taiwan citizens are required to receive their coverage through NHI. While this may sound limiting, Chen argues that it guarantees more options for patients.
“You can walk into any contracted provider,” said Chen to a crowd of 70 people in the Campus Center. “With 92% of providers (labs, hospitals, etc.) under contract with NHI, that gives patients over 18,000 choices. While broadening the options, it also helps to cut out one of those prime evils of health insurance.”
Red tape: Most providers are still in the private sector, but because they all fall under NHI there are no questions of which hospital takes what insurance, which doctor you can see, or if you are covered for particular treatments. This streamlined approach creates ease of use. Every patient has a Smart Card and with a single swipe a physician can access your previous treatments, medications, and tests. Then, before you leave, you give another swipe and your bill is paid.
“The benefits package covers virtually everything,” said Chen. “Vision, dental, and herbal medicine are all covered.”
But with coverage like that, the cost must be high. Not so says Chen. On average, those covered through NHI pay an annual premium of $1,000 a year after their employer covers 70%. There are still co-pays, but those help to stave off abuses of the system.
The costs are kept low because the system is designed to operate efficiently from the ground up. The single-payer model brings with it a centralized information hub where everything flows through the same system. With the use of the Smart Card system NHI is paperless, insuring a swift transfer of data.
Implemented in the system is a utilization review of providers, taking advantage of the organization to spot abuses and failed services. It makes it easier to locate inconsistencies such as fraud committed by the insured. Expansive surveys can also be performed on data sets to determine adjustments that may be needed.
With these advantages, NHI is able to keep its administrative costs low, in turn allowing it to keep its premiums at a semi-consistent level. Administration takes up only 1.3% of medical costs compared to the U.S. costs of 20%.
While the system is far from perfect, Chen argued that coverage for all trumps any grievances.
“The real bottom line is that the program can take care of everyone, especially the disadvantaged. In my view that’s the real bottom line,” said Chen.

In the U.S., the topic of health care reform has been a point of contention for years, and has resurfaced as President Obama passed his health care reform bill. Opponents argue that it is impractical and unsustainable in its current format, but Obama trumpets the right to health care as being the bottom line and not the costs that come with it. Could Taiwan’s model work in the States?
“It would be fantastic, but I don’t think right now our political economy would be able to compromise,” said Mike White, President of the Camden Economics Society. “We are not at where we need to be financially as a country.”
Chen did take time to point out some other issues with Taiwan’s NHI, noting that because the cost of doctors is cheap for everyone, there is a high rate of visitation. Doctors are stretched thin and forced to spend shorter amounts of time with patients to meet the demand. But if there is a lack in quality care, you are always free to go to another provider.
This freedom of choosing providers diminishes the rationing of care. Chen made a point to commend the doctors and surgeons in Taiwan. Making on average one tenth of the average U.S. counterpart, the doctors work longer hours to meet the demands. He chalks it up to the human effort and the belief that everyone deserves to have quality care.
“You can make a good system bad, and you can make a bad system good,” said Chen.

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