Taiwan has created a successful health care system modeled on Canada. We should now learn from them

This column is an opinion of harmeet Nanner, research analyst at the Center for Addiction and Mental Health in Toronto. For more information on CBC’s Opinion section, please see the FAQ.

In the 1970s, Taiwan began an effort to radically transform its health system. Strengthening its supply of health care resources to serve a rapidly industrializing country is the first priority, but the most complex issue is how to finance health care services while ensuring equitable access for all.

In the late 1980s, a task force of experts was set up to address this issue and William Hsiao, a Harvard economics professor renowned for his work on health care financing, was selected as an adviser. major.

Professor Hsiao undertook an economic study of insurance schemes in six countries: the United States, the United Kingdom, Germany, France, Canada and Japan. The results were in favor of a single-payer system based on Canada’s experience with Medicare in the 1980s, when the quality of services was very high. This helped spur Taiwan to adopt a single-payer framework as well, a program they call National Health Insurance (NHI).

The task force learned from the successes and failures of Canada and more than a dozen other countries in building an ideal system for Taiwan. Therefore, our systems may look very different, even though they share the same basic framework.

Taiwan very good at controlling costs

The research and data process has resulted in a fine-tuned system, so that the NHI can provide comprehensive coverage for dental care, prescription drugs, physical rehabilitation, etc., while keeping costs tight. – and he is very good cost control.

In 2017, Taiwan’s National Health Expenditure (NHE) was 6.1% of GDP; the OECD average that year was 8.8%, and Canada’s NHS was 10.4%. Most impressive is the amount of performance squeezed out of every dollar; While Canadians have spent the past two decades increasingly haunted by wait times, Taiwan’s system stands out for its minimal wait times.

Am I suggesting that Taiwan has the perfect system? Definitely not. There are glaring problems and some aspects may be unacceptable to Canadians, but the efficiency of the system means Taiwan has plenty of room to increase its health care budget to fill the gaps.

On the other hand, Canada’s health care system is simply tragic. We see it at its worst right now, but our system has been failing Canadians for a number of years, especially with wait times.

Like Professor Hsiao Remarks, Health care in Canada began its decline in the 1990s, when funding tightened during a recession. However, the Canadian system has always lacked certain features that would maximize the efficiency with which we use the resources we pay for.

Even now, Canada’s NHE is among the highest in the OECD.

Paramedics offload patients at Toronto Western Hospital. With the tragic state of health services, we can finally have the motivation we need to fix our system, writes Harmeet Nanner. (Evan Mitsui/CBC)

What exactly do we get for such high costs? According to the Commonwealth Fund, which made a very complete comparison health care in 11 different countries (Taiwan is not one of them), Canada has the worst universal health care system.

Some may assume that the message of this article is for Canada to emulate the specific policies and procedures on which Taiwan has built its system, but that is actually not all. What I want us to imitate is treat Taiwanese authorities have used to achieve healthcare success, a process of mobilizing global knowledge and drawing on a diverse group of experts to create effective policy solutions.

The working group that led to the creation of INSA distinguished itself by the way it crossed borders in order to obtain the best information available. The Canadian federal government should also convene a task force of experts to make recommendations on comprehensive health care reform, not only on the issue of funding and health insurance, but for all the components that make up the system, such as policies that can enable health care delivery.

Politics is the hardest part

The difficult part of this plan is the politicians and the federalism. Our governments may very well convene panels of experts to make recommendations, but they are horrible at implementing them, at least when it comes to health care. Several government-sanctioned reports have been produced in the past to advise on methods to improve, modernize and sustain the health system, but these reports have been largely ignored.

In 2002, following the publication of Romanow Commission report, a poll found that a majority of Canadians approved of it, but 39% were pessimistic that his advice would be followed. Unfortunately, those Canadians were right, but if they had been wrong, we probably wouldn’t have as many emergency rooms closed right now.

Those who remember past advisory reports may scoff at my suggestion as another pointless attempt to reform health care, a waste of money making recommendations that will go nowhere. I do not agree.

The discussions I often hear about reforming the system, from the public, the media and governments, fall far short of the most transformative and well-researched solutions. In the worst-case scenario, a task force of experts would help introduce alternatives into the public dialogue, which would help today’s voters understand exactly what kinds of policies their governments should support.

The best case scenario is, of course, that these policies are adopted. With the tragic state of health services, the masses of health care workers pushed to the brink, the obvious failure compared to other OECD countries and a single-payer model in Taiwan, we can finally have the motivation we need to fix our beloved healthcare system.

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