The US health care system is not founded on universal accessibility, implying that there still exists a lot of pressure on the sprawling healthcare system. Various organizations, insurance companies, healthcare providers, and independent firms provide healthcare services to the citizens. Internationally, the US exhibits a lagging health care system compared to other countries such as Taiwan. Contrary to the approach adopted in the US, Taiwan demonstrates a universal and mandatory coverage of healthcare. Besides such differences, the US and Taiwan are incredibly variable in various aspects of healthcare, including coverage and access, organization, delivery, and payment, and cost control. This report is based on the Commonwealth Fund primary data for either county in terms of healthcare.
Health System Features/Components & Comparisons
Healthcare Coverage & Access
The healthcare system developed in the US is not a universal one compared to Taiwan’s mandatory universal coverage. The structure embraced in the US encompasses a mix of public, private, for-profit, and nonprofit firms. However, in Taiwan, most of the services are offered by contracted private firms. The type of administration used in the US was initiated before that used in Taiwan. Until presently, the US still relies on the initial public insurance programs, which include Medicare, Medicaid, Children’s Health Insurance Program., and Affordable Care Act (Salmond & Echevarria, 2017). Taiwan has only relied on the National Health Insurance Act, controlled by the government under social services.
The government plays various roles, such as setting legislation, administering healthcare programs, and funding health insurance in the US (The Commonwealth Fund, 2021a). However, the government of Taiwan plays a minor role, especially in the financing of care (The Commonwealth Fund, 2021b). The government may intervene in offering premiums to low-income families and other disadvantaged households. Taiwan has a structured health information structure that makes up the National Health Insurance Administration (NHIA). Most of the tasks, including overseeing health services utilization and quality, are left to the NHIA.
In the US, the federal government has few interventions, especially in the supply of providers (The Commonwealth Fund, 2021a). Furthermore, most of the tasks are left to the states, which offer various healthcare programs to their members. Financing is also partly made by the states, especially by the working-class citizens. Veterans and low-income people are also well-covered by Medicaid in the US healthcare system. While the NHIA in Taiwan is left to perform most of the tasks in healthcare, the parliament still plays a critical role in watching over NHI matters.
Healthcare Organization, Delivery, & Payment/Reimbursements
The health organization in the US is different from that of Taiwan. In the US, the structure is based on public and private financing. Under public financing, the federal and state governments are involved. In Taiwan, the government plays minor roles in delivering care services; hence, it all starts with the Ministry of Health and Welfare that controls the NHI under NHIA. The duties are distributed across various divisions, which are then later transferred to the hospitals and clinics. Furthermore, the US system is complex as privately insured individuals also exhibit some of the state and federal government roles. As such, the order developed in the US is comparatively weak compared to that of Taiwan.
The delivery system organization is also distinct for the US and Taiwan. Medical schools are open to the public in the US, whereas Taiwan has limited medical school admissions in both private and public medical schools. Primary care physicians in the US earn their income from different sources, including private and public insurance (The Commonwealth Fund, 2021a). However, the practitioners in Taiwan are paid on a fee-for-service basis (The Commonwealth Fund, 2021b). Little competition for services is perceived in the US compared to Taiwan, where the payment system prompts practitioners to initiate a competition for patients. Other sources of income for Taiwan doctors include patient admission fees, coinsurance, and the sale of services and goods not covered by the NHI (The Commonwealth Fund, 2021b).
Since the government controls most of its practices in the US, strict hours are set beyond which physicians may not attend to patients. However, some private clinics offer the services upon appointment. There are no such strict regulations in Taiwan as primary care physicians may provide services to the registered patients. The two countries have both private and public hospitals. However, hospitals in the US draw their income from insurance systems, whereas those in Taiwan get their income from direct payments from the NHIA. Similar practices are perceived for the two countries regarding outpatient service delivery and the administrative mechanisms utilized for direct payments. There are no mandatory requirements for healthcare coverage in the US compared to Taiwan, where enrolment is administered at birth.
Cost Control/Containment
In the containment of healthcare costs, the US healthcare organization follows the National Quality Strategy provisions (The Commonwealth Fund, 2021a). Hospitals across the US must report the selected quality measures implemented every year (The Commonwealth Fund, 2021a). To ensure such quality and meet patient needs satisfactorily, Taiwan’s strategies are based on payment incentives, claims management and reviews, and information-sharing and transparency (The Commonwealth Fund, 2021b). Similar to the reporting done by the US hospitals, Taiwan hospitals reassures access and quality care by reporting to a claims review system, which measures the extent to which various criteria have been met. Additionally, Taiwan focuses on multiple niches, including stroke and burn patients, which are not present in the US healthcare system.
The complex US system makes it difficult for the country to reduce disparities controllably. While the government exists at the top of the healthcare structure, federal agencies are left to monitor and address inequities. There is a need to develop effective programs and policies and provide grants to disadvantaged communities. Taiwan focuses on a simple healthcare organization, where the NHIA ensures that even the disadvantaged population can access healthcare services. Other advantages perceived from the system include the ability to issue interest-free loans for healthcare access, which is absent in the US.
Coordinated care is a norm in Taiwan as the system is based on financial incentives. Furthermore, the system is well integrated to ensure that even the low-income communities can access hospital services. In the US, healthcare integration and care coordination is based on the Affordable Care Act (ACA) (Salmond & Echevarria, 2017). In terms of containment, the ACA ensures that quality and safe services are offered, costs are favorable for the population, and that healthcare services are accessible regardless of geographical locations.
Overall Summary
The US and Taiwan healthcare systems are comparatively different in all aspects, including coverage and access, organization, delivery, payment, and cost control. Surprisingly, Taiwan’s population is entirely covered for healthcare compared to the US system, where healthcare is offered through plans such as Medicare and Medicaid. Taiwan’s healthcare system is more superior compared to the lagging and ineffective US healthcare system. Taiwan has the best healthcare services outcomes compared to the US and still exhibits commendably integrated and coordinated approaches to healthcare.
References
Salmond, S., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopaedic Nursing, 36(1), 12-25. https://doi.org/10.1097/nor.0000000000000308
The Commonwealth Fund. (2021a). International Health Care System Profiles: United States. Commonwealthfund.org. Retrieved 12 July 2021, from https://www.commonwealthfund.org/international-health-policy-center/countries/united-states.
The Commonwealth Fund. (2021b). International Health Care System Profiles: Taiwan. Commonwealthfund.org. Retrieved 12 July 2021, from https://www.commonwealthfund.org/international-health-policy-center/countries/taiwan.
