In preparation for becoming an aged society, Taiwan has promoted active aging by encouraging lifelong learning and helping senior citizens join the job market.
The overall health of Taiwan’s people has improved considerably over the past several decades, with a steady rise in their standards of living and advances in the health and medical sciences. Increasingly sedentary lifestyles and unbalanced diets have given rise to a new set of health challenges, however, with cancer and chronic cardiovascular diseases replacing communicable illnesses as leading threats.
In 2015, cancer accounted for 28.6 percent of all deaths in Taiwan, nearly 50 percent of which were of lung, liver or colorectal cancer (in order of frequency). Nevertheless, increased early detection and screening have reduced the death and disability rates associated with these conditions.
National Health Insurance
Taiwan’s National Health Insurance (NHI) 全民健康保險 has been touted worldwide for providing equal access to quality health care. Over 99 percent of ROC nationals are covered by this public program, and all citizens and foreign residents who have lived in Taiwan for at least six months are required to enroll.
The NHI system was established in 1995 and provides comprehensive and uniform benefits. The insured have access to more than 20,000 contracted health care facilities around the country providing inpatient and ambulatory care, dental services, traditional Chinese medicinal therapies, obstetric services, physical rehabilitation, home care and chronic mental illness care. Most forms of treatment, including surgery, are covered by the system, as are examinations, laboratory tests, anesthesia, prescription medication, medical supplies, nursing care, hospitalization and certain over-the-counter drugs.
Premiums and Copayments
The payment of each insurant’s premium is typically divided between the insurant, his or her employer, and the government, with their respective contribution ratios varying based on the nature of the insurant’s employment (see table “NHI Premium Contribution Ratios”). Certain groups’ premiums are fully subsidized by the government; such coverage was extended to inmates in correctional facilities by the Second-generation NHI (which is explained in the next section).
The insured have complete freedom of choice of medical service providers. To access an NHI-contracted medical facility or pharmacy in Taiwan, patients need only make a copayment and pay a small registration fee. For inpatient care, a progressive rate depending on the intensity of care and length of stay applies.
Taiwan’s graying population, costly new drugs and treatments, as well as lifetime coverage for chronic illness, rare diseases and catastrophic illnesses have strained the NHI’s finances. Accordingly, the National Health Insurance Act 全民健康保險法 was amended in 2011 to expand the premium base while reducing the financial burden on salaried employees.
The revised act requires the government to fund at least 36 percent of the NHI budget, excluding funding from the Health and Welfare Surcharge on Tobacco Products 菸品健康福利捐 and lottery proceeds. Implemented in January 2013, the Second-generation NHI features a 2-percent supplementary premium charge on income from stock dividends; interest earnings; rental income; payments received for professional practice; income from secondary employment or part-time work; and annual bonuses exceeding four months of an employee’s regular salary. All such payments are now reported to the National Health Insurance Administration 中央健康保險署 for premium collection.
Medical Care System
As of the end of 2015, around 280,500 medical professionals worked in Taiwan. There were 21.41 physicians (including physicians of Chinese medicine) and 5.75 dentists per 10,000 people. In order to ensure that quality medical service is available to all citizens, higher salary and transportation subsidies are offered to doctors and nurses who practice in rural or remote areas.
In 2015, there were 494 hospitals and 21,683 clinics operating in Taiwan. These medical institutions had a total of 162,163 beds, or about 69 beds per 10,000 people.
Health Concerns and Health Promotion
Healthy Birth and Growth
A raft of measures and facilities are in place to ensure the health of mothers and infants: Baby-Friendly Hospitals and preventive health care services are provided, including 10 different free prenatal examinations and a number of subsidized prenatal genetic diagnoses, access to breastfeeding-friendly environments, and newborn screening services with follow-up diagnoses and treatment upon detection of any abnormalities. Centers for assessing child development have been established so that early intervention can be offered for those with developmental delays. Pediatric counseling and seven other preventive services are given to children as well.
Following the 2012 initiation of a pilot program offering compensation for injuries sustained during childbirth, the Legislature in December 2015 approved legislation regarding dispute resolution and compensation for injuries incurred during labor.
Obesity Prevention and Control
Obesity is associated with non-communicable diseases such as diabetes, cancer, heart disease, cerebrovascular disease, metabolic syndrome, hypertension and dyslipidemia. Since 2011, the government has implemented a weight management program to proactively encourage citizens to examine and address obesogenic environments and adopt a healthy lifestyle, while also offering weight control counseling services to the public. Partly because of this program, the growth of the obese population has slowed since 2013.
Tobacco Hazards Control
In recent years, the public and private sectors have adopted a strict stance on controlling tobacco hazards. The Tobacco Hazards Prevention Act 菸害防治法 prohibits smoking in indoor areas such as workplaces shared by three or more persons, karaoke lounges, restaurants and Internet cafes, as well as outdoor public areas such as hospital campuses and spaces near the entrances of railway stations. Local authorities have also banned smoking in areas adjacent to school campuses since 2012. Beginning April 2014, visitors and staff of all public recreation areas, including national parks, may only smoke in designated areas. Furthermore, since 2009, warning labels on tobacco products have been required by law to cover 35 percent of principal pack surfaces.
The Health and Welfare Surcharge on Tobacco Products is NT$20 (US$0.60) per standard pack. Revenue from this surcharge goes into the National Health Insurance Reserve Fund 全民健康保險安全準備基金 and is used to subsidize NHI premiums for the economically disadvantaged, as well as to support smoking cessation services, tobacco hazard awareness campaigns, cancer prevention, social welfare and improvement of public health and medical care. A second-generation smoking cessation scheme launched in 2012 has been implemented at hospitals, clinics, and community pharmacies.
The National Cancer Prevention and Control Program 國家癌症防治計畫 has been implemented since 2005 to reduce cancer mortality through education, free screening services, improvement of diagnoses and treatment, and promotion of hospice and palliative care. The program’s third phase (2014-2018) shifts the focus from screening and treatment to prevention. Its three new emphases are as follows:
- Controlling emerging risk factors (obesity, unhealthy diets and physical inactivity), monitoring and addressing obesogenic environments, conducting the National Nutrition Program 現代國民營養計畫, and doubling the share of the population that exercises regularly.
- Promoting evidence-based cancer screening policies, especially for precancerous lesions that are precursors of colon cancer and oral cancer.
- Implementing the Cancer Patient Navigation Program 癌友導航計畫 to make every life count, cure early-stage cancers and provide palliative care for end-stage patients.
Chronic Disease Prevention and Control
National and local public health agencies have joined forces to promote awareness and prevention of hypertension, hyperglycemia and hyperlipidemia. To detect chronic diseases and their risk factors early on, preventive health care services are provided free of charge every three years to people age 40 to 64 and annually to indigenous people age 55 and older as well as all people at least 65 years of age. Additionally, a nationwide network for chronic disease care has been constructed, and Taiwan’s 22 counties and cities have joined diabetes shared care networks and diabetes/chronic kidney disease health promotion institutions to further enhance care quality.
Due to its low fertility rate, Taiwan is expected to become an aged society, defined as a society in which over 14 percent of the population is age 65 or above, by 2018, and a super-aged society, in which senior citizens account for at least one-fifth of the total population, by 2025.
To raise the quality of life of the nation’s senior citizens and slow the progression of chronic diseases, the Ministry of Health and Welfare (MOHW) has supported age-friendly cities, age-friendly health care, health promotion for the elderly, and prevention and control of chronic diseases. A total of NT$10 billion (US$299.85 million) has been earmarked to build elderly day care centers in the nation’s 368 townships and districts by the end of 2016, while an elderly employment resource center was launched in 2014 to bring employable senior citizens into the job market.
In addition to ensuring the availability of comprehensive health care through the NHI system, in cases where expenses are not covered under the National Health Insurance Act, the MOHW subsidizes the costs of diagnosis, treatment, pharmaceuticals and special nutrients for patients with rare diseases under the Rare Disease and Orphan Drugs Act 罕見疾病防治及藥物法. It also maintains a distribution logistics center for nutrients and orphan drugs specially formulated for treatment of rare diseases and subsidizes laboratory testing in partnership with other nations.
Demographic aging, longer life expectancy and changes in disease patterns have increased the need for long-term care. In 2007 the Executive Yuan 行政院 launched the National 10-year Long-term Care Plan 我國長期照顧十年計畫, under which subsidies are available for people who need assistance in their daily lives because of a functional disorder. The subsidies cover home nursing care and rehabilitation, acquisition or rental of assistive devices, and adaptation of homes into free-access environments as well as meals, transportation, respite care and other institutional services. The MOHW is also implementing a Long-term Care Service Network 長期照護服務網 plan through the end of 2016 to establish long-term care institutions, ensure quality control, train personnel and develop care resources in rural areas.
To follow up on these two plans, the Cabinet in November 2015 approved a NT$30 billion (US$940.44 million) program to further boost the development of long-term care services through 2018. In January 2016, the MOHW launched a long-term care resources web portal that includes a searchable map with information on home care, community care and nursing homes. The Long-term Care Services Act was greenlighted by the Legislature in May 2015 (see box “Long-term Care Services Act”).
Prevention and control of infectious diseases such as tuberculosis, hepatitis, dengue fever and enterovirus have significantly improved in Taiwan in recent decades. In addition to the Communicable Disease Control Act 傳染病防治法, several disease surveillance systems, including the Real-time Outbreak and Disease Surveillance System 即時疫情監視及預警系統, the School-based Surveillance System 學校傳染病監視通報資訊系統 and the Taiwan Nosocomial Infections Surveillance System 院內感染監視通報系統, have been established to collect timely, comprehensive and precise information on infectious diseases. Meanwhile, the MOHW’s Centers for Disease Control 疾病管制署 has been working in collaboration with medical care and academic research institutes to better understand epidemics and formulate prevention and control measures.
In April 2016, Taiwan inaugurated a national research center for mosquito-borne diseases such as dengue fever and the Zika virus. In collaboration with local governments and schools, the center will monitor disease vectors, carry out clinical trials and establish an improved early warning system.
Traditional Chinese Medicine
Traditional Chinese medicine is a popular type of therapy covered by the NHI. As of July 2015, Taiwan had 6,146 licensed practitioners, 3,654 pharmacies and 3,637 Chinese medicine clinics and hospitals.
The MOHW’s Department of Chinese Medicine and Pharmacy 中醫藥司 oversees the practice of Chinese medicine in Taiwan and supports research on pharmaceutical development, acupuncture and other traditional practices. The manufacture and sale of traditional Chinese medicines in Taiwan are subject to strict regulations as well as mandatory certification procedures.
Regulation and Oversight
The MOHW’s Food and Drug Administration (FDA) 食品藥物管理署 ensures food and drug safety and is a liaison on such matters for the public. With inspectors stationed at all entry points to the country, the FDA is responsible for assuring the safety and effectiveness of human drugs, vaccines and other biological products, medical devices, dietary supplements, foodstuffs and cosmetics.
Several food safety management mechanisms have been set up in Taiwan to address basic food production processes in factories, temperature controls during transportation, food storage and handling in retail operations and food preparation at eateries. Other mechanisms include inspection of imported products, promotion of food safety education in schools, and monitoring of advertisements for and labeling of food products.
The FDA has established a task force to assess risks in food products and the environment arising from chemical contaminants, food additives, pesticides, heavy metals and biological toxins. Such assessments provide a scientific foundation for risk management and formulation of food safety policies.
In the wake of several food safety incidents, the Act Governing Food Safety and Sanitation 食品安全衛生管理法 was amended in five rounds between 2013 and 2015 to safeguard public health. The amendments, which aim to end the use of unapproved additives in and illegal adulteration of food products, focused on food testing, inspection and control as well as strengthening food safety risk management. The revised act requires that related government agencies set up a food safety monitoring system and that local food manufacturers establish a tracking system for the production and trade of food. Certain manufacturers are required to conduct a self-inspection of their ingredients and products or send them to third-party laboratories for examination. In addition, penalties have been stepped up on an array of illegal food-related activities.
Taiwan also participates in a number of food-related world bodies. Through such cooperative forums, it strives to establish national food safety standards that comply with international norms.
The ROC began to implement Good Manufacturing Practices 優良藥品製造標準 for the pharmaceutical industry in 1982 and the more stringent current Good Manufacturing Practices (cGMP) 現行優良藥品製造標準 in the 1990s. Such certifications are contingent on passing routine inspections as well as unannounced investigations due to specific concerns.
Taiwan joined the international Pharmaceutical Inspection Convention and Pharmaceutical Inspection Cooperation Scheme (PIC/S) in early 2013. From 2015 onwards, all pharmaceutical manufacturers must obtain manufacturing authorization from the MOHW based on their PIC/S GMP inspection results. The manufacturers shall be subject to routine and unannounced inspections to make sure of their compliance.
In 2016, the central government allocated NT$460.61 billion (US$13.81 billion) to public welfare, accounting for 22.3 percent of its total budget. The target groups may be summarized as follows.
Taiwan’s under-18 age group (referred to herein as “children”) has been shrinking in recent years as birth rates have declined. To encourage childbearing and reduce the burdens of child care, a childrearing allowance for unemployed parents with children under age two has been made available for certain families since 2012. Moreover, each parent of a newborn who is covered by employment insurance and who elects to take unpaid parental leave can receive a monthly Employment Insurance Fund 就業保險基金 allowance for up to six months. Subsidies have also been provided since 2015 to help infertile couples seek professional assistance with artificial reproduction.
Since 2009, NHI premium subsidies have been available for medical treatment of children belonging to households in the low- and lower-middle-income brackets (see “Disadvantaged Households” section for bracket definitions). Children whose basic living needs are jeopardized are entitled to receive emergency subsidies for up to six months at a time, while mentally or physically challenged children can also receive aid for early treatment and education.
A system for reporting and preventing child abuse has been established in line with the Protection of Children and Youths Welfare and Rights Act 兒童及少年福利與權益保障法, the Domestic Violence Prevention Act 家庭暴力防治法 and the Sexual Assault Crime Prevention Act 性侵害犯罪防治法. The Protection of Children and Youths Welfare and Rights Act requires that persons and government agencies responsible for children’s well-being must take immediate action to protect them upon discovering or being informed of any condition that endangers their well-being. The system includes 24-hour hotlines, medical treatment and protective placement as well as assistance by police and prosecutorial authorities.
Other legal protections for children can be found in the Criminal Code of the Republic of China 中華民國刑法, which requires lengthy prison sentences for adults who engage in sexual intercourse with children under 16; the Child and Youth Sexual Exploitation Prevention Act 兒童及少年性剝削防制條例, which mandates imprisonment, detention and fines for any actions involving sexual exploitation of anyone under the age of 18; the Labor Standards Act 勞動基準法, which stipulates that youngsters under 15 may not work unless they have already graduated from junior high school and been approved by a competent authority and that they, as well as all 15-year-olds, shall be considered child workers who may not work more than eight hours a day, work night shifts, or handle heavy or hazardous work; and the Implementation Act of the Convention on the Rights of the Child 兒童權利公約施行法, effective in November 2014, which formally brought Taiwan’s protection of children’s rights and interests in line with international standards.
Taiwan became an aging society as defined by the World Health Organization when its elderly population (65 or older) crossed the 7-percent threshold in 1993. At the end of 2015, 12.51 percent of the population was elderly.
The Senior Citizens Welfare Act 老人福利法 addresses the rights and welfare of the elderly, providing for an annuity system to safeguard the financial security of elderly people as well as living subsidies and special care allowances for financially disadvantaged senior citizens. The act stipulates that offspring or contractual welfare institutions that mistreat, abuse or abandon elderly people are subject to fines; that their names be published; and that individual offenders attend family education courses.
Under the National 10-year Long-term Care Plan, which has a 10-year budget of NT$81.70 billion (US$2.59 billion), the MOHW allocates funds to local governments for the provision of day care and home care for the elderly and for setting up support centers that teach nursing skills to family members and professional caregivers.
Other services provided include free health checkups and influenza vaccinations; discounts on public transportation and access to cultural and educational facilities; day care and home care services; lifelong learning programs and social activities; and free meal delivery.
Currently 1,069 publicly and privately funded care centers provide institutional care services to the elderly. Senior citizens in low- and lower-middle-income households who are not receiving institutional care are granted monthly living allowances of NT$7,463 (US$224) and NT$3,731 (US$112), respectively.
In addition, local governments provide a monthly special care allowance of NT$5,000 (US$150) to low- and lower-middle-income households taking care of elderly persons unable to perform basic activities of daily living. In 2015, around 9,470 households received such subsidies. They also received subsidies for hospital care and denture implants.
As of the end of 2015, 4.92 percent of Taiwan’s population was registered as disabled. A variety of public and private institutions serve people with specific disabilities such as vision, hearing and speech impairments, autism and chronic psychosis. Services provided range from long-term nursing care to training and development programs.
The physically challenged receive tax exemptions, free-of-charge public transportation and access to public recreational and scenic spots, subsidies for medical expenses and social insurance premiums, preferential loans, and vocational guidance and training. Disabled persons are entitled to an income-tax deduction of NT$128,000 (US$3,838), while disabled students enjoy tuition reductions ranging from 40 to 100 percent, depending on the severity of their condition, if the annual income of the household to which they belong is less than NT$2.2 million (US$65,967).
Other financial support for the disabled includes monthly national pension payments and, for those in low- and lower-middle-income households, monthly living allowances ranging from NT$3,628 (US$109) to NT$8,499 (US$255). Those who reside in caregiving facilities are also subsidized up to NT$21,000 (US$630) per month, depending on their household income and degree of disability.
The People with Disabilities Rights Protection Act 身心障礙者權益保障法 requires that disabled persons constitute at least 1 percent of the work force at private enterprises with 67 or more employees and at least 3 percent of the work force at government offices, public schools and state-owned enterprises with 34 or more employees. Employers can receive monthly reimbursements of NT$12,000 (US$360) for each disabled person employed after reference by a public job placement center. Persons with disabilities participating in state-run or government-commissioned vocational training programs can receive allowances equal to 60 percent of the nation’s minimum monthly wage for up to one year.
Taiwan’s indigenous peoples constitute approximately 2 percent of the total population. The Indigenous Peoples Basic Law 原住民族基本法 obligates the central government to provide resources to help indigenous groups govern their own affairs, formulate policies to protect their basic rights, and promote the preservation and development of their languages and cultures.
The Indigenous Peoples Employment Rights Protection Act 原住民族工作權保障法 stipulates that indigenous peoples should make up at least 1 percent of the work force at government agencies, public schools and state-owned enterprises with 100 or more employees and at least one-third of the work force for any such organizations if they are located in indigenous communities.
Other provisions for the indigenous peoples include living allowances for indigenous senior citizens; subsidies for preschool day care and nursery care; emergency assistance; tuition subsidies, scholarships and work-study grants; indigenous community health services; low-interest housing loans and rent subsidies; and subsidies for National Health Insurance premiums and medical treatment.
The Farmer Health Insurance (FHI) 農民健康保險 program, which includes cash benefits for disability, maternity and funeral expenses, provides coverage to all people who are 15 years of age or older, engage in agricultural work for at least 90 days a year, and do not receive old-age pension payments from other social insurance programs.
In addition, farmers who are 65 or older and have resided in the ROC for over 183 days each of the past three years are entitled to a monthly pension of NT$7,000 (US$210) so long as they have been insured under the FHI for at least 15 years and are not receiving pension payments from other social insurance programs.
In accordance with the Public Assistance Act 社會救助法, the MOHW, together with local government agencies, implements a variety of programs that provide financial and practical assistance to low- and lower-middle-income households. Some provide relatively long-term aid, others short-term aid in emergency situations.
Low-income households are defined as those whose monthly average per-member gross income is less than the monthly “minimum living expense” level of the region in which they reside, which is defined as 60 percent of the average monthly disposable income there. Lower-middle-income households are defined as those whose monthly average per-member gross income is less than 1.5 times the region’s monthly minimum living expense.
The MOHW’s Immediate Assistance Program 馬上關懷急難救助 provides short-term emergency living subsidies and practical relief to disadvantaged households as well as to households whose well-being is threatened by the recent death, disappearance, unemployment, severe injury or illness of their chief income earners. Emergency aid ranging between NT$10,000 (US$300) and NT$30,000 (US$900) is provided along with a variety of welfare services.
The Act of Assistance for Family in Hardship 特殊境遇家庭扶助條例 stipulates that single parents of families whose basic needs are not being met due to extraordinary contingencies shall be provided with subsidies encompassing a wide variety of emergency conditions, including payments for daily living costs, health care, children’s education, legal expenses and interest payments on business startup loans.
The national pension 國民年金 serves citizens who are not covered by social insurance programs for laborers, farmers, members of the military, civil servants and teachers, ensuring that the vast majority of citizens receive regular, lifelong pension benefits. As of the end of 2015, the program covered 3.50 million people.
Insurants may join the program after turning 25 years old and receive monthly payments for the rest of their lives upon reaching the age of 65, with each citizen’s payment amount depending on how much he or she paid into the system over the years. Those who were already 65 at the time of the program’s implementation are exempt from paying premiums but receive monthly payments of NT$3,500 (US$105). Low-income and severely disabled insured persons pay no premiums, while subsidies of up to 70 percent of premium costs are provided to less disadvantaged individuals.
Labor Pension and Labor Insurance Pension
The Labor Pension Act 勞工退休金條例 allows workers to join the labor pension program administered by the Ministry of Labor’s Bureau of Labor Insurance (BLI) 勞工保險局. The program offers portable individual labor pension accounts into which employers pay monthly premiums amounting to at least 6 percent of their employees’ monthly wages, while employees may elect to contribute up to 6 percent of their monthly wages themselves.
Persons who reach the age of 60 after having participated in the program for at least 15 years are eligible to claim monthly pension payments regardless of whether they are still working. Those 60 or over who have been in the program for less than 15 years cannot receive monthly payments and must withdraw their labor pension in one lump sum.
As for the country’s labor insurance system, eligible workers insured before January 2009 can choose to receive annuity payments monthly until they pass away or to collect a lump sum, while workers first insured after January 2009, when the Labor Insurance Pension (LIP) scheme 勞保年金制度 was implemented, can only receive monthly payments. Like the aforementioned labor pension system, the LIP is administered by the BLI.
In response to demographic changes, the government is currently planning amendments to the labor pension and LIP programs as well as the military, civil servant and teacher pension systems to ensure their long-term sustainability.
• Ministry of Health and Welfare: http://www.mohw.gov.tw
• National Health Insurance Administration: http://www.nhi.gov.tw
• Health Promotion Administration: http://www.hpa.gov.tw
• Centers for Disease Control: http://www.cdc.gov.tw
• Department of Chinese Medicine and Pharmacy, Ministry of Health and Welfare: http://www.mohw.gov.tw/CHT/DOCMAP
• Food and Drug Administration: http://www.fda.gov.tw
• Council of Indigenous Peoples: http://www.apc.gov.tw
• Ministry of the Interior: http://www.moi.gov.tw
• Bureau of Labor Insurance, Ministry of Labor: http://www.bli.gov.tw