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Apology to bring up Taiwan again in the same thread. Taiwan's national health insurance was once praised by Michael Porter and other Nobel prize laureates. It

Apology to bring up Taiwan again in the same thread. Taiwan's national health insurance was once praised by Michael Porter and other Nobel prize laureates. It was marveled as the best invention to bring to the masses. Basically, Taiwan congress establishes a fixed budget for health care for next year. Then no matter how many patients or how expensive it runs next year, National Health Insurance Administration pays the hospital proportionally by assigning "points" to treatments. For example, pulling one wisdom tooth is 10 points. 1 point is 1 dollar last year then 10 points earn the hospital 10 dollar last year. This year it may go down to 0.8 dollar per point then 10 points mean 8.8 dollar due to more patient visits/treatment higher cost nationally. All the while, the cost of treatment hasn't really changed. Now when NHI started out, it was indeed 1 TWD per point. Now it has gone to 0.5 TWD per point. (Detail varies, this is the gist of it). Hospital jobs are not as good as it used to be nowadays.

brianwawok 9y ago
What happens if the pay per point is too low to retain employees, and all the doctors move to the US? What is to discourage a doctor from doing a 6 point procedure even though a 3 point procedure has a better or same outcome for the patient?
- cvsh 9y ago
  Indeed, it sounds like a perverse incentive to compete in an arms race of increasingly expensive procedures
- juiyout 9y ago
  1. Out of top 200 hospitals in the world, Taiwan has 14 of them only behind US and Germany. It is nice considering our population is only 23 million. Clinical technologies and results has been excellent in facial reconstruction, live transplant, heart transplant, fertility preservation, joint replacement, to name a few. Talents has been serving global clients where more money can be earned. (Somewhat like our IT export) Interestingly though, instead of moving overseas, prospective doctors move into high earning fields where National Health Insurance does not cover, for example, cosmetic surgeries. 2. Yes, business nature is to pump the points up. However, there is required monthly and annual reports to NHI. NHI has complete authority to deduct the points and fine you if they think you are cheating the system. And here the best part, you can appeal to the very same NHI for another review. They usually stand by their original decision from what I have heard. (This sounds just like Apple and its App Store.)
  - brianwawok 9y ago
    That sounds pretty good. I wonder what it would take to scale to America scale.
    - juiyout 9y ago
      It indeed is great for the masses. For doctors, as you voiced earlier, has been pretty ugly. They have to find work outside of country or move to other fields trying to earn money from treatments not covered by NHI. One more subtle effect is that people start to treat medical service as a cheap service and it is common to see its abuse. In Taiwan, a piece of candy is usually more expensive than a pill.

brianwawok 9y ago

What happens if the pay per point is too low to retain employees, and all the doctors move to the US? What is to discourage a doctor from doing a 6 point procedure even though a 3 point procedure has a better or same outcome for the patient?

cvsh 9y ago
Indeed, it sounds like a perverse incentive to compete in an arms race of increasingly expensive procedures
juiyout 9y ago
1. Out of top 200 hospitals in the world, Taiwan has 14 of them only behind US and Germany. It is nice considering our population is only 23 million. Clinical technologies and results has been excellent in facial reconstruction, live transplant, heart transplant, fertility preservation, joint replacement, to name a few. Talents has been serving global clients where more money can be earned. (Somewhat like our IT export) Interestingly though, instead of moving overseas, prospective doctors move into high earning fields where National Health Insurance does not cover, for example, cosmetic surgeries. 2. Yes, business nature is to pump the points up. However, there is required monthly and annual reports to NHI. NHI has complete authority to deduct the points and fine you if they think you are cheating the system. And here the best part, you can appeal to the very same NHI for another review. They usually stand by their original decision from what I have heard. (This sounds just like Apple and its App Store.)
- brianwawok 9y ago
  That sounds pretty good. I wonder what it would take to scale to America scale.
  - juiyout 9y ago
    It indeed is great for the masses. For doctors, as you voiced earlier, has been pretty ugly. They have to find work outside of country or move to other fields trying to earn money from treatments not covered by NHI. One more subtle effect is that people start to treat medical service as a cheap service and it is common to see its abuse. In Taiwan, a piece of candy is usually more expensive than a pill.