Health System Reform in the Republic of China

Some of the experiences of Taiwan in formulating a market-based health care system may be relevant to countries looking to the market to reform their health system. Taiwan's experience reaffirms the difficulty of regulating and controlling health care utilization within a fee-for-service system. Effective regulation and administration of health care require not only political will but also technical understanding. Holding patients accountable for costs is not incompatible with a program of national health insurance coverage. For instance, during the past six years, Taiwan has moved toward providing universal coverage but has also opted for higher patient copayments to control utilization of services. This contrasts with models of national health insurance in other countries such as Canada and Germany, which have avoided patient copayments.