Value-based healthcare in Taiwan - Economist Impact
Value-based
healthcare in Taiwan
Towards a leadership
role in Asia
S P ON S ORE D BY:
Value-based healthcare in Taiwan: Towards a leadership role in Asia
Contents
About this report
2
Introduction3
1. The institutional backdrop
Institutional history
Reimbursement
Pricing
4
5
6
6
2. Pilot programmes and efforts to identify stakeholders
Expenditure remains a worry
Experimentation still ad-hoc
Public health and prevention a priority
8
8
9
9
3. Where value measures should focus
Infectious diseases
Seeing value in preventative health
New challenges and paths forward
11
11
12
13
Conclusion16
? The Economist Intelligence Unit Limited 2017
1
Value-based healthcare in Taiwan: Towards a leadership role in Asia
About this report
Value-based Healthcare in Taiwan: Towards a
leadership role in Asia is an Economist Intelligence
Unit (EIU) report, commissioned by Gilead
Sciences. It is the latest in a series of reports
which examines the development of value-based
healthcare in countries around the world.
University and director, Taipei Medical University
BioHealth Global Executive Program
Our thanks are due to the following for their time
and insight (listed alphabetically):
l Po-Chang Lee, director-general, National
Health Insurance Administration, Taiwan Ministry
of Health and Welfare
l K Arnold Chan, professor, National Taiwan
University College of Medicine and director,
National Taiwan University Health Data Research
Center
l Hong-Jen Chang, chairman and chief
executive, YFY Biotech, Taiwan
l Hsiu-Hsi Chen, professor of epidemiology and
statistics, College of Public Health, National
Taiwan University
l Yi-Hsin Elsa Hsu, associate professor, School
of Health Care Administration, Taipei Medical
2
? The Economist Intelligence Unit Limited 2017
l Joey Kwong, collaborate researcher, National
Center for Child Health and Development, Tokyo,
and recent visiting professor, Cochrane Taiwan,
Taipei Medical University
l Jasmine Pwu, director, National Hepatitis C
Program, Ministry of Health and Welfare, and
former director, HTA division, Centre for Drug
Evaluation, Taiwan
The EIU bears sole responsibility for the content
of this report. The findings and views expressed
in the report do not necessarily reflect the views
of the sponsor. Andrea Chipman was the author of
the report, and Michael Gold was the editor.
Value-based healthcare in Taiwan: Towards a leadership role in Asia
Introduction
A value-based approach to healthcare is
gradually gaining traction in Taiwan, as the
country¡¯s healthcare system confronts the
opportunities and pressures of innovative new
medical treatments along with a growing burden
of both chronic and infectious diseases.
Taiwan¡¯s healthcare system benefits from more
than 20 years of universal access to healthcare,
which has helped to create a comprehensive set of
data available to researchers. Health technology
assessment has been in place in parts of the system
for more than a decade.
Although there are increasing efforts to introduce
cost-effectiveness and broader measures of ¡°value¡±
into analysis and decision-making about new
medical treatments, there has been no effort so far
to accept either a common understanding of value,
or a standardised approach toward evaluating
healthcare with regard to this measure.
¡°The concept of value-based health is not new
territory in Taiwan, although a universal definition
and thorough understanding of what constitutes
¡®value¡¯ in healthcare is currently lacking,¡± says
Joey Kwong, collaborate researcher at the
National Center for Child Health and Development,
Tokyo, Japan and a recent visiting professor at
the Cochrane Taiwan project at Taipei Medical
University. ¡°The 2025 Health and Welfare Policy
White Paper has specifically highlighted the
importance of findings from evidence-based
medicine research in establishing both effective
and ineffective medical indicators to enhance
patient care and quality, as well as reduce medical
waste.¡±
Any efforts to move Taiwan along in the process
of establishing value measures will need to look
at several key issues that have an impact on the
future course of value-based healthcare: how the
country¡¯s healthcare decision-making institutions
interpret value; who the main stakeholders with
an input into the decision-making process are
and should be; and what aspects of healthcare
can logistically be evaluated within a value-based
framework. In addition, experts say the health
system will need to find ways to use its healthtechnology assessment (HTA) capabilities to
identify low-value areas where it is prudent to
reduce investment in order to free up resources for
more cost-effective expenditures. This process will
require a more integrated use of HTA to evaluate
not only medical treatments and devices, but entire
care pathways.
? The Economist Intelligence Unit Limited 2017
3
Value-based healthcare in Taiwan: Towards a leadership role in Asia
1
Stewart, G, BrooksRooney, C, ¡°An Overview of
New Health Technologies and
Reimbursement Structures
in Taiwan¡±, slideshow
presentation by Costello
Medical Consulting, http://
costellomedical.
com/wp-content/
uploads/2014/03/ISPORBeijing-PresentationHandout.pdf, slide 2
The institutional backdrop
Taiwan¡¯s citizens benefit from one of the oldest
government-administered, insurance-based
national health services in Asia, and one of
the few in the region that provides universal
coverage. Established in 1995, the single-payer
model health insurance programme is now
managed by the National Health Insurance
Administration (NHIA) and covers 99% of the
country¡¯s population. Expenditure on health
accounts for a comparatively low 6% of GDP.
Access and Quality Index, out of 195 countries and
territories surveyed. The Index, which measured
mortality from causes ¡°amenable to personal
healthcare¡±, was previously compiled in 1990.2
The system is notable for comparatively low
costs, comprehensive benefits, short waiting
times, and completely free access to doctors,
clinics and hospitals of the patients¡¯ choice.1 The
benefits package includes a list of thousands of
prescription drugs, according to Ms Kwong.
Increasingly, says Jasmine Pwu, director of the
National Hepatitis C office under the Ministry
of Health and Welfare (MOHW) and a former
director of the HTA division at Taiwan¡¯s Center for
Drug Evaluation (CDE), the government is being
challenged about how it evaluates research, the
brand value of drug manufacturers and, to a
greater extent, the patient perspective.
The single-payer structure of the Taiwanese
system enables it to set and regulate fees, as well
as impose a global budget, helping the NHIA to
control costs, a 2015 article by the Brookings
Institution points out.3
1
¡°Healthcare Access and
Quality Index based on
mortality from causes
amenable to personal
healthcare in 195 countries
and territories, 1990-2015:
a novel analysis from the
Global Burden of Disease
Study 2015¡±, The Lancet,
18 May 2017, .
journals/
lancet/article/PIIS01406736(17)30818-8/
fulltext?elsca1=tlpr
Taiwan¡¯s health system was ranked 45th in the
Global Burden of Disease Study¡¯s 2015 Healthcare
2
Cheng, TM, ¡°Taiwan¡¯s
health system: the next
20 years¡±, Brookings
Institution, 14 May 2015,
.
edu/opinions/taiwanshealth-care-system-thenext-20-years/
Healthy planet
Performance in the Healthcare Access and Quality Index, select economies,
2015
(Score out of 100)
88
Canada
78
Taiwan
68
Colombia
Belize
3
4
95
Andorra
58
49
Indonesia
38
Chad
Central African Republic
29
Source: The Lancet
? The Economist Intelligence Unit Limited 2017
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