OPINION | Taiwan created a successful health-care system by learning from Canada. We should now be learning from them | CBC News


This column is an opinion by Harmeet Nanner, a analysis analyst on the Centre for Dependancy and Psychological Well being in Toronto. For extra details about CBC’s Opinion section, please see the FAQ.

Within the Seventies, Taiwan started an effort to radically transform its health-care system. Increase its provide of health-care assets to serve a quickly industrializing nation was the primary precedence, however the extra advanced downside was how health-care providers ought to be funded whereas offering equitable entry for all. 

Within the late 80s, an knowledgeable process drive was commissioned to deal with this challenge, and William Hsiao, a Harvard economics professor famend for his work on health-care financing, was chosen as chief advisor. 

Prof. Hsiao started an financial examine of insurance coverage schemes in six nations: the U.S., the U.Ok., Germany, France, Canada and Japan. The outcomes have been in favour of a single-payer system based on Canada’s experience with medicare within the 80s, at which period the standard of providers was very excessive. This helped affect Taiwan to additionally undertake a single-payer framework, a program they name the Nationwide Well being Insurance coverage (NHI).

The duty drive realized from each the successes and failures of Canada and over a dozen different nations to piece collectively a system that was superb for Taiwan. Consequently, our methods can look fairly totally different, although they share the identical primary framework. 

Taiwan superb at controlling prices

The analysis and data-driven course of has allowed for a finely-tuned system, such that the NHI can present complete protection for dental, pharmaceuticals, bodily rehabilitation, and extra, all whereas placing a good lid on prices — and it’s very good at controlling costs

In 2017, Taiwan’s nationwide well being expenditure (NHE) was 6.1 per cent of GDP; the OECD common that yr was 8.8 per cent, and Canada’s NHE was 10.4 per cent. Most spectacular is how a lot efficiency is squeezed out of each greenback; whereas Canadians have spent the final 20 years more and more haunted by wait instances, the Taiwanese system is notable for having minimal wait times

Am I suggesting that Taiwan has the right system? Positively not. There are some obvious points and a few points could also be unacceptable to Canadians, however the system’s effectivity signifies that Taiwan has a lot of room to extend its health-care funds to deal with shortcomings. 

Then again, Canada’s health-care system is solely tragic. We’re seeing it at its worst proper now, however our system has been failing Canadians for quite a few years, most clearly with wait instances. 

As Prof. Hsiao notes, Canadian well being care started its descent within the Nineties, when funding grew tight throughout a recession. Nevertheless, the Canadian system has at all times been lacking sure options that may maximize how effectively we use the assets we’re paying for. 

Even now, Canada’s NHE is among the many highest within the OECD. 

Ambulance paramedics unload sufferers at Toronto Western Hospital. With the tragic state of health-care providers, we could lastly have the motivation we have to repair our system, writes Harmeet Nanner. (Evan Mitsui/CBC)

What precisely can we get for such excessive prices? In keeping with the Commonwealth Fund, which made a very comprehensive comparison of well being care in 11 totally different nations (Taiwan shouldn’t be one in every of them), Canada has absolutely the worst system of common care. 

Some could assume that the message of this text is for Canada to emulate the precise insurance policies and procedures that Taiwan has constructed their system out of, however that is really not it. What I need us to emulate is the course of that Taiwanese officers used to attain their well being care success, a technique of mobilizing the world’s information and counting on a various group of consultants to create efficient coverage options. 

The duty drive which led to the creation of the NHI was notable for the way it reached throughout borders to be able to get the most effective data accessible. The Canadian federal authorities ought to equally deliver collectively an knowledgeable process drive to make suggestions on complete well being care reform, not simply on the problem of funding and medical health insurance, however for all elements that make up the system, equivalent to insurance policies that may allow more practical well being care supply. 

Politics is the toughest half

The troublesome a part of this plan is the politicians and federalism. Our governments will be fairly good about calling knowledgeable teams collectively to make suggestions, however they’re horrible at implementing them, not less than because it pertains to well being care. A number of government-sanctioned studies have been produced previously to advise on strategies of enhancing, modernizing, and sustaining the health-care system, however these studies have largely been ignored. 

In 2002, following the publication of the Romanow Commission report, one ballot discovered {that a} majority of Canadians authorized of it, however 39 per cent were pessimistic that its advice would be followed. Sadly, these Canadians have been proper, however had they been fallacious, we in all probability would not have so many shuttered ERs for the time being. 

Those that bear in mind previous advisory studies could scoff at my suggestion as one other ineffective try and reform well being care, a waste of cash to make suggestions that can go nowhere. I disagree. 

The discussions I typically hear about reforming the system, within the public, media, and from governments, are far faraway from the options which might be probably the most transformative and well-researched. Within the worst case, an knowledgeable process drive would assist thrust options into the general public dialogue, and this may assist the voters of right now to know simply what kinds of insurance policies their governments ought to be supporting. 

The perfect case is, in fact, that these insurance policies undergo. With the tragic state of health-care providers, droves of health-care employees pushed to the brink, the clear failure relative to different OECD nations, and a single-payer position mannequin in Taiwan, we could lastly have the motivation we have to repair our beloved health-care system.


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