“In 1986 Taiwan’s government began planning to provide universal health insurance for its citizens. At the time, 41 percent of Taiwan’s population (8.6 million people) was uninsured and either paid for care out of pocket or went without it. The objective was to provide every citizen with timely access to needed health care, on equal terms, without unduly burdening the budgets of households, but also with effective controls on the growth of overall health spending.
In the relatively short time from the late 1980s to 1994, Taiwan’s health policy planners carefully studied alternative health care systems around the world. This global survey persuaded the planners to consolidate the more than ten insurance programs then in existence in Taiwan into a single-payer government-run health insurance system modeled after the Canadian provincial health plans, but coupled with a financing scheme inspired by Germany’s payroll-based premium system. 1
The legislation for implementing the reform was passed in July 1994, and the implementation began March 1, 1995. Uptake of the new insurance program was swift. By the end of 1995, 92 percent of Taiwan’s population was enrolled in the National Health Insurance (NHI). 2
This year marks the twentieth anniversary of Taiwan’s major health reform. The rapid uptake of reform can be attributed to a “window of opportunity” presented by the confluence of several enabling factors: strong public demand, strong political leadership, competition between rival political parties, and the need to control double-digit growth in health care spending. 1(p73) Other facilitating factors were decades of high economic growth; a well-educated and highly motivated civil service; and a preexisting national health care service network, which provided the delivery capacity for the NHI. 3
Reflections On The 20th Anniversary Of Taiwan’s Single-Payer National Health Insurance System. Tsung-Mei Cheng, Health Affairs 2015 34:3, 502-510