What are the ways to ensure sustainability for Taiwan's NHI? NHI suggests (1) raising premiums & deductibles. The Taiwan Medical Alliance for Labor Justice & Patient Safety says (2) premiums should only be raised for people who frequently visit hospitals. https://www.taipeitimes.com/News/taiwan/archives/2020/10/10/2003744933

What else? NHI says that while NHI medical expenses increased 95% from 2000 to 2017, there were actually 0.3% fewer people who visited hospitals and average hospital visits per person increased from 12 to 14. Meanwhile, minimum wage increased by only 50%.

So what's the problem here? Looking at the wage-price equation, it can be assumed that NHI reserves are depleting because while medical costs have been increasing, wages have not caught up, and therefore NHI premium payments have also stagnated & could not catch up with costs.

So, what others solutions are there to NHI? Surely, wage increases is a commonsensical solution? We cannot keep cutting down on medical costs and quality simply because we do not want to increase wages? What else? Why not peg premiums and out-of-pocket payments to wealth?

I have resisted pegging premiums & out-of-pocket payments to wealth because I believe that as a basic necessity, people should not be deprived from healthcare & it should therefore be afforded universally. However, such ideology works in the Nordic countries which are more equal.

However, while Taiwan on the surface has low income inequality, Taiwan's wealth inequality is actually one of the highest among developed countries, which means that the wealthy in Taiwan are not carrying their share of the NHI burden.

Thing is, Taiwan has one of the world's highest business ownership rate, which means that as wages continue to be depressed, bosses continue to earn high profits (Taiwan's profit share is one of the highest among advanced countries).

Thus, looking at it as a whole, Taiwan's NHI is being depleted because part of the increments that could be accorded to higher wages and higher premium payments are being deprived because of the profit withholding by wealthy bosses.

The easy way out is of course to increase premiums and out-of-pocket payments, but such a universal move will impact on the low-income heavily. The side effects would be poorer health outcomes for the poor and higher inequality in access to healthcare. Is this what we want?

Sensible and more sustainable long-term approaches should require (1) wage increments to match the level of costs escalation, so as to increase premium payments, and (2) in view of the extravagant wealth inequality, to peg premium % and out-of-pocket payments to wealth.

We shouldn't be looking at piecemeal and patchwork solutions to patching up the NHI, because then we are only pushing the problem down the road. We should be looking at the fundamental problems, and addressing them at the root.

Taiwan's NHI system is very valuable, and people coming from systems like US and Singapore (like me) have witnessed how hugely unequal healthcare systems can lead to lower access. So, we should be careful not to undo the good of NHI, because getting it back would be difficult.

While I agree that NHI premiums could perhaps be increased, why isn't talk of wage increases part of that equation? Wage, costs & premiums should interact in tandem to ensure sustainability - this should be part of the long-term decision making for the @MOHW_Taiwan's NHI system.

The NHI is a good system and what supported Taiwan's #COVID19 fight. @MOHW_Taiwan needs to develop sustainable approaches to managing it, and not piecemeal, patchwork approaches. @iingwen needs to take the lead in ensuring a whole-of-society approach is taken ...

... to understand the economic, social and psychological reasons for overuse, and then implement customized approaches at ensuring the sustainability of the NHI. While increasing premiums & out-of-pocket payments are the easy way out, the social impacts would need to be studied.