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March 8, 1995, Vol 273, No. 10 >
ARTICLE | March 8, 1995

Health System Reform in the Republic of China: Title and subTitle BreakFormulating Policy in a Market-Based Health System FREE

John W. Peabody, MD, DTM&H, PhD; Joanna Chih-I Yu, RPh, MHA; Yi-Ren Wang, MS; Stephen R. Bickel, MD, MBA, MPH
[+] Author Affiliations

Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

This investigation is the result of work begun during a class on International Comparative Research in the RAND Graduate School taught by Drs David Finegold and Roger Benjamin. All opinions, omissions, or errors are those of the authors.

Reprint requests to RAND, 1700 Main St, Santa Monica, CA 90407-2138 (Dr Peabody).


JAMA. 1995;273(10):777-781. doi:10.1001/jama.1995.03520340033032
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References

IN RECENT years, the Republic of China, often referred to as Taiwan, has been on a course similar in many ways to that of the United States as it has tried to navigate its way through health system reform. Like the United States, Taiwan's reform initiative began in response to two primary factors: access to care problems and rising costs of health services. Lack of health insurance for 46% of the population was another contributing cause. Government officials, facing social insurance plans with large deficits, and politicians using the issues of cost and access to appeal to the public, pushed reform efforts forward. Although important differences between the two countries exist, they share similar challenges of large-scale health system reform in market-based economies. Since Taiwan began its reform process in 1987, its experience previews the reform process and highlights another policy perspective for the United States.

Economic and Cultural Influences 

REFERENCES

1 +
Economist. World in Figures . London, England:Economist Press; 1993;.
2 +
Human Development Report . New York, NY: United Nations Development Programme; 1990;:17-41.
3 +
Meier GM. Leading Issues in Economic Development . 5th ed. New York, NY: Oxford University Press; 1989;:62-66.
4 +
Baum WC, Stokes MT. Investing In Development: Lessons of World Bank Experience . New York, NY: Oxford University Press; 1985;:5-13, 575-593.
5 +
Western Pacific Regional Office, World Health Organization. Western Pacific Region Data Bank on Socioeconomic and Health Indicators . Manila, the Philippines: World Health Organization; 1990;.
6 +
Chen CL.  Child health in Taiwan. Acta Paediatr Sin . 1988;;29( (suppl B) ): 23B-25B.
7 +
Department of Health. Health and Vital Statistics, 1993: Republic of China . Taipei, Taiwan: The Executive Yuan, Department of Health; September 1994;: 62-84
8 +
Wen CP.  Health in the midst of economic development in Taiwan. Med Care . 1974;;12:85-94.
9 +
Tsai WH.  Industrialization and health care in Taiwan.  In: Zeichner CI, ed. Modern and Traditional Health Care in Developing Societies: Conflict and Cooperation . Lanham, Md: University Press of America; 1988;:35-47.
10 +
Tsai SP, Wen CP.  Mortality comparisons in a rapidly developing economy in Taiwan, part 1: comparison with the U.S.A. and Japan, 1976-1983. Asia Pac J Public Health . 1989;;3:41-50.
11 +
World Bank. World Development Report: Investing in Health . New York, NY: Oxford University Press; 1993;:238-314.
12 +
Department of Health. The Progress in Planning and Implementing a National Health Insurance Program . Taipei, Taiwan: The Executive Yuan, Department of Health; 1993;.
13 +
Chiang TL. Health Care Delivery in Taiwan: Progress and Problems . Taipei, Taiwan: The Institute of Economics, Academia Sinica; 1987;.
14 +
Hsiao WCL, Yaung CL, Lu JFR. Current System of Health Care Financing and Delivery in R.O.C. and Its Challenge for Future Development . Taipei, Taiwan: National Health Task Force; 1989;.
15 +
Briefing, Department of Health . Taipei, Taiwan: The Executive Yuan, Department of Health; February 8, 1993;.
16 +
Department of Health. Statistics of Medical Facilities and Health Workers . Taipei, Taiwan: The Executive Yuan, Department of Health; 1993;.
17 +
Schieber G, Poullier JP, Greenwald LM.  U.S. health expenditure performance: an international comparison and data update. Health Care Financ Rev . Summer 1992;;13( (4) ):1-87.
18 +
Chen CW.  University hospitals in the Republic of China. Kao Hsiung I hsueh Ko Hsueh Tsa Chih . 1987;;3:446-453.
19 +
Yaung CL. Current System of Health Care Financing and Delivery in R.O.C. and Its Challenges for Future Development. Presented at International Symposium on Health Care Systems; December 18-19, 1989; Taipei, Taiwan.
20 +
Health Statistics: Taiwan Provincial Health Department, Taipei City Health Department, and Kaoshiung City Health Department . Taipei, Taiwan: The Executive Yuan, Department of Health; 1987;.
21 +
Organisation for Economic Co-operation. OECD Health System . Paris, France: Organisation for Economic Co-operation; 1993;. Health Policy Studies No. 3.
22 +
Bureau of Labor Insurance for Taiwan—Fukian Area. Statistical Data for Taiwan—Fukian Area . Taipei, Taiwan: Bureau of Labor Insurance Bureau; June 1993;:256-257.
23 +
National Health Insurance Task Force. Health Care Expenditures . Taipei, Taiwan: Executive Yuan, Department of Health; 1993;.
24 +
Lin S. National Health Expenditures in Taiwan . Taipei, Taiwan: Social Welfare and Economic Department, Chinese Economic Association; 1994;.
25 +
Peabody JW, Lee SW, Bickel SR.  Health for all in the Republic of Korea: one country's experience with universal medical coverage in a private health care system. Health Policy . January 1995;;31( (1) ):29-42.
26 +
Yeh C.  Mixed views on health bill. China Post . (July 19) , 1994;:1, 16.
27 +
Blendon RJ, Hyams TS, Benson JM.  Bridging the gap between expert and public views on health care reform. JAMA . 1993;;269:2573-2578.
28 +
Hammond KR, Grassia J.  The cognitive side of conflict: from theory to resolution of policy disputes.  In: Oskamp S, ed. International Conflict and National Public Policy Issues . Beverly Hills, Calif: Sage; 1985;;6:233-254.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Economist. World in Figures . London, England:Economist Press; 1993;.
2 +
Human Development Report . New York, NY: United Nations Development Programme; 1990;:17-41.
3 +
Meier GM. Leading Issues in Economic Development . 5th ed. New York, NY: Oxford University Press; 1989;:62-66.
4 +
Baum WC, Stokes MT. Investing In Development: Lessons of World Bank Experience . New York, NY: Oxford University Press; 1985;:5-13, 575-593.
5 +
Western Pacific Regional Office, World Health Organization. Western Pacific Region Data Bank on Socioeconomic and Health Indicators . Manila, the Philippines: World Health Organization; 1990;.
6 +
Chen CL.  Child health in Taiwan. Acta Paediatr Sin . 1988;;29( (suppl B) ): 23B-25B.
7 +
Department of Health. Health and Vital Statistics, 1993: Republic of China . Taipei, Taiwan: The Executive Yuan, Department of Health; September 1994;: 62-84
8 +
Wen CP.  Health in the midst of economic development in Taiwan. Med Care . 1974;;12:85-94.
9 +
Tsai WH.  Industrialization and health care in Taiwan.  In: Zeichner CI, ed. Modern and Traditional Health Care in Developing Societies: Conflict and Cooperation . Lanham, Md: University Press of America; 1988;:35-47.
10 +
Tsai SP, Wen CP.  Mortality comparisons in a rapidly developing economy in Taiwan, part 1: comparison with the U.S.A. and Japan, 1976-1983. Asia Pac J Public Health . 1989;;3:41-50.
11 +
World Bank. World Development Report: Investing in Health . New York, NY: Oxford University Press; 1993;:238-314.
12 +
Department of Health. The Progress in Planning and Implementing a National Health Insurance Program . Taipei, Taiwan: The Executive Yuan, Department of Health; 1993;.
13 +
Chiang TL. Health Care Delivery in Taiwan: Progress and Problems . Taipei, Taiwan: The Institute of Economics, Academia Sinica; 1987;.
14 +
Hsiao WCL, Yaung CL, Lu JFR. Current System of Health Care Financing and Delivery in R.O.C. and Its Challenge for Future Development . Taipei, Taiwan: National Health Task Force; 1989;.
15 +
Briefing, Department of Health . Taipei, Taiwan: The Executive Yuan, Department of Health; February 8, 1993;.
16 +
Department of Health. Statistics of Medical Facilities and Health Workers . Taipei, Taiwan: The Executive Yuan, Department of Health; 1993;.
17 +
Schieber G, Poullier JP, Greenwald LM.  U.S. health expenditure performance: an international comparison and data update. Health Care Financ Rev . Summer 1992;;13( (4) ):1-87.
18 +
Chen CW.  University hospitals in the Republic of China. Kao Hsiung I hsueh Ko Hsueh Tsa Chih . 1987;;3:446-453.
19 +
Yaung CL. Current System of Health Care Financing and Delivery in R.O.C. and Its Challenges for Future Development. Presented at International Symposium on Health Care Systems; December 18-19, 1989; Taipei, Taiwan.
20 +
Health Statistics: Taiwan Provincial Health Department, Taipei City Health Department, and Kaoshiung City Health Department . Taipei, Taiwan: The Executive Yuan, Department of Health; 1987;.
21 +
Organisation for Economic Co-operation. OECD Health System . Paris, France: Organisation for Economic Co-operation; 1993;. Health Policy Studies No. 3.
22 +
Bureau of Labor Insurance for Taiwan—Fukian Area. Statistical Data for Taiwan—Fukian Area . Taipei, Taiwan: Bureau of Labor Insurance Bureau; June 1993;:256-257.
23 +
National Health Insurance Task Force. Health Care Expenditures . Taipei, Taiwan: Executive Yuan, Department of Health; 1993;.
24 +
Lin S. National Health Expenditures in Taiwan . Taipei, Taiwan: Social Welfare and Economic Department, Chinese Economic Association; 1994;.
25 +
Peabody JW, Lee SW, Bickel SR.  Health for all in the Republic of Korea: one country's experience with universal medical coverage in a private health care system. Health Policy . January 1995;;31( (1) ):29-42.
26 +
Yeh C.  Mixed views on health bill. China Post . (July 19) , 1994;:1, 16.
27 +
Blendon RJ, Hyams TS, Benson JM.  Bridging the gap between expert and public views on health care reform. JAMA . 1993;;269:2573-2578.
28 +
Hammond KR, Grassia J.  The cognitive side of conflict: from theory to resolution of policy disputes.  In: Oskamp S, ed. International Conflict and National Public Policy Issues . Beverly Hills, Calif: Sage; 1985;;6:233-254.

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