On the 30th anniversary of Taiwan’s National Health Insurance (NHI) system, CAPRI hosted a hybrid roundtable session to discuss its successes and fragilities. Joseph Wong, senior fellow at CAPRI and vice president, international, at the University of Toronto, and Chang-Chuan Chan, CAPRI board member and distinguished professor in the Global Health Program, College of Public Health, National Taiwan University, joined experts and former policymakers for this discussion. Together, they reflected on the NHI’s achievements, examined structural barriers, and explored reforms needed to ensure future resilience.
Taiwan’s NHI, introduced in 1995, has provided affordable universal health coverage for three decades while maintaining public satisfaction above 90%. However, shifting demographics and increasing medical needs bring into question the system’s long-term sustainability. Moreover, its funding structures and institutional practices have become “locked in” over time, making reforms both politically and administratively challenging. As decision-making is highly centralized at the cabinet and presidential level, healthcare policy is shaped more by short-term political cycles than by long-term planning.
The financing system compounds these limits. Taiwan’s main tool for containing costs is the global budget, a capped amount allocated for healthcare services provided to citizens. While effective in the early years, it is now reaching its limits. Rising demand, including new medical technologies, more intensive treatments for chronic diseases such as cancer and diabetes, and expanded services for mental health, continues to outpace available resources. Yet the budget cap has not grown proportionately, leaving both patients and providers caught between raising expectations and constrained funding.
Physicians and nurses are consistently paid below market rates. Although the government has announced plans to raise wages, the increases remain marginal compared with other industries, making healthcare an unattractive option for new graduates. In addition, hospitals are incentivized to maximize service “points” to claim a larger slice of the budget. Since the overall budget is capped, this competition only reshuffles portions of the same fixed pie rather than expanding resources. This intensifies pressure on health professionals to deliver more services but does little to improve the quality of care or address structural workforce shortages.
A recurring theme in the discussion was the gap between public perceptions and policy realities, as well as the broader misalignment between the healthcare system and societal expectations. Universal healthcare should reflect shared norms, yet in Taiwan, public preferences are rarely systematically collected. Without clarity on the public’s expectations of the health system and how much they are willing to pay into it, building consensus for reforms will remain difficult.
Despite these challenges, Taiwan has important strengths to build on. The participants emphasized that the next stage of reform will require greater transparency and accountability, clearer lines of responsibility in governance, and open, evidence-based debate to bridge the divides between policymakers, providers, and the public. The roundtable highlighted both the achievements and vulnerabilities of Taiwan’s healthcare system, echoing the findings of CAPRI’s report on the Taiwanese health system as part of the Partnership for Health System Sustainability and Resilience. The NHI has been a remarkable success story, ensuring universal coverage of healthcare and access across the country. Persistent distribution challenges both between hospitals and among rural and urban populations continue to affect Taiwan’s health system. The discussion emphasized the importance of strengthening public health literacy to support more informed decision-making.
