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Taiwan's Single-Payer System

发表于 1-13-2020 16:22:07 | 显示全部楼层 |阅读模式
Dylan Scott, Taiwan's Single-Payer Success Story — and Its Lessons for America; The first in a Vox series on how countries around the world achieve universal health care. Vox.com, Jan 13, 2020.
https://www.vox.com/health-care/ ... an-health-insurance

(a) "Thirty years ago, before she dyed her hair pink to cover up the white, Dr Huei-wen Tien 田惠文 [卑南族人 (so she could not communicate with her patients at first, from different tribes and speaking different tribal languages); 老家在台東; 高雄醫學院醫學系畢業; 秀林鄉衛生所 主任] came to Xiulin, a township on the east coast of Taiwan severed from the island's urban centers by a formidable mountain range.  She had agreed to serve for 10 years in an aboriginal community in exchange for her medical education. Unconventional by nature — her motorcycle helmet says 'Punk' * * * Tien then inserted the woman's national health insurance card 健保卡 into a chip reader to pull up her medical record on the computer. The cards are ubiquitous in Taiwan, the signature of its single-payer health care system, carried by everyone * * * In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders's vision of Medicare-for-all as anything in the world.  I came here last October to learn what it takes to set up and sustain such a system. It’s one of several stops around the globe that Vox made this past fall, in an effort to learn how other countries tried to achieve universal and affordable health care. Our project, Everybody Covered, was made possible by a grant from The Commonwealth Fund.
(i) 秀林鄉
(太魯閣語 [language of 太魯閣族]: Bsuring; 位於台灣花蓮縣)
(ii) The website Vox.com is owned by Vox Media (2005- ; based in Washington DC; digital only -- no print).
(iii) Commonwealth Fund
(1918- )

(b) " 'Canada and virtually all European and Asian developed nations have reached, decades ago, a political consensus to treat health care as a social good,' health care economist Uwe Reinhardt wrote in his book Priced Out shortly before his death in 2017. 'By contrast, we in the United States have never reached a politically dominant consensus on the issue.' "
(i) Uwe Reinhardt
(1937 (Osnabrück, Germany) – 2017 (princeton); was a professor of political economy at Princeton University; section 3 Private industry and advisory roles, section 3.1 Role in Taiwan's healthcare system and award: "In 1989, as Taiwan was restructuring its healthcare system, Reinhardt persuaded its leaders to model it on those of Canada and Germany. Taiwan's system now provides universal care for 6.6% of GDP. For his contribution, in 2014 he was awarded the nation's Presidential Prize")
(ii) Osnabrück
(section 1 Name)
(iii) Uwe (proper name): "a male given name popular from the 1930s to the 1960s"
(A) Category:Uwe Reinhardt. Wikipedia Commons
("104 [2015] 年3月17日 馬英九總統主持贈勳典禮-頒授美國哈佛大學蕭慶倫博士、普林斯頓大學經濟學教授任赫德 [Uwe Reinhardt] 博士「紫色大綬景星勳章」 ")

Yes, in Chinese (other text in English).
(B) 總統頒授美國哈佛大學教授蕭慶倫、普林斯頓大學經濟學教授任赫德「紫色大綬景星勳章」. 總統府新聞, 中華民國104年03月17日
("馬英九總統今(17)日上午在總統府頒授美國哈佛大學教授蕭慶倫(William Ching-Lung Hsiao)、普林斯頓大學經濟學教授任赫德(Uwe Ernst Reinhardt)「紫色大綬景星勳章」,表彰渠等對協助我國規劃全民健康保險制度的卓越貢獻。 * * * * * * 總統指出,我國自1995年開辦全民健保迄今屆滿20週年 * * * 總統說,過去臺灣鄉下常發生民眾因無法負擔保證金而難以就醫的情形,使得貧窮與疾病經常被劃上等號;然而,全民健保制度已打破這個等號,人們不會因為貧困而無法就醫,「你窮沒有關係,你的病,政府會照顧你」,此即為全民健保的重大貢獻。 * * * 包括任赫德教授夫人鄭宗美、「美國在臺協會」臺北辦事處副處長酈英傑(Brent Christensen)、總統府秘書長曾永權以及衛生福利部中央健康保險署署長黃三桂等均在場觀禮")
(C) 景星勳章

official terms of Taiwanese government:
• 景星勳章 Order of Brilliant Star  景星勳章
• 紫色大綬景星勳章 Order of Brilliant Star With Violet Grand Cordon
(D) 鄭宗美   Tsung-Mei Cheng. Health Policy Research Analyst, Woodrow Wilson School of Public & International Affairs, Princeton University

Her degrees earned are LLB, MA (from where I do not know).

(c) "In the 1980s, Taiwan wasn't yet a democracy, but the stirrings of popular rule could be felt. At the time, about 40 percent of Taiwanese people lacked health insurance [including my whole clan of Cantonese, which is not something we ever thought about, because everybody  paid cash for everything -- there was no credit card and because everybody wanted to avoid paying tax] — some people lost everything, even their house, if they had a medical crisis. Desperate to outflank reformers, the ruling government convened high-profile meetings to fix its health care system.  One guest at a 1989 conference was the German-born Reinhardt, a Princeton economist who was married to Taiwan-born scholar Tsung-Mei (May) Cheng."
(i) 鄭先祐 Cheng, Hsien Yu (Ayo), 新聞彙錄  Ayo [阿祐] 短評.  2012年8月份
("● 美國全民健保過關,CNN報導「師法台灣」。紛擾多時的美國全民健保法案,終於由聯邦最高法院做出歷史性裁決,強制納保的規定並不違憲,對於美國總統歐巴馬來說,這是他任內一大勝利,也為年底的選情大加分;美國健保改革法案一直以來無法搞定,CNN曾經製作專題,讚揚台灣的全民健保,可做為美國的借鏡,不過台灣健保其實也有一堆問題,CNN似乎只看到表象。CNN主持人札卡利亞 [Fareed ZAKARIA] 讚美台灣全民健保,以驚人的低成本,提供高品質的醫療保障,美國健保支出佔了GDP17%,台灣只佔7%,其實當初台灣規劃全民健保,也曾想向美國取經。哈佛大學教授蕭慶倫:「從美國可以學到什麼不該做,而非該做什麼。」CNN專題探討台灣健保如何運作,1995年全民健保上路,由政府支持,採行單一保險制度,全民一起納保。札卡利亞:「台灣的未保險率1年內,從41%驟降到8%,台灣擁有備受好評的健保制度。」美國健保制度又貴又沒效率,早就為人詬病,台灣健保財務經由單一平台運作,透過每人一張的健保卡,追蹤紀錄每個人的就醫次數和醫療花費。札卡利亞:「相較之下,美國健保只能夠每2年評估到底有多少醫療支出,在台灣,醫療花費每天都有紀錄。」醫療支出由健保局統一管理,完全不會限制民眾就醫,只要有病就能看醫生,看看數字統計就知道。札卡利亞:「美國人平均每年就醫4次,台灣人幾乎是1年14次。」普林斯頓大學教授鄭宗美:「而且台灣人住院時間較美國人長,平均住院天數是10天,美國是5天。」有病就去醫,台灣健保支出之所以能壓低,是因為給付給醫療院所的費用也偏低,醫生每看1個病人大概只能拿14美元,反觀美國醫生每看1人,就有100美元進帳。(2012/8/1, ref. TVBS)")
(ii) The author 鄭先祐  is 國立臺南大學 環境與生態學院 教授 Professor, College of Environmental Science and Ecology, National Tainan University.

(d) "Yi Jie Li [李怡潔], a 25-year-old woman with spinal atrophy and an outspoken advocate who wrote the 2017 book 7,300 Days: The Most Ordinary Luxury" 7300最平凡的奢侈 (時報出版社, whose 序 (by 鐘育志 國立交通大學生物科技學院院長) said: "7300天除以365就是20年,20歲對一般人來說是正值花漾年華、青春年少之際,也是人生起步飛翔的開始,可是對SMA [Spinal Muscular Atrophy] 病友來說,卻是她們生存上一道難以跨越的鴻溝").
(e) Philosophically I am leaning toward Republican Party. I am a capitalist. And sSingle-payer system sounds like socialism to me.

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