November 13, 2020

Lessons from Taiwan: An Aging Population

Our program intern recently attended the 2016 Duke Health Forum: “The Emerging Healthscape: from Personalized Medicine to Population Health”. At the event participants compared and contrasted healthcare in Taiwan and the United States and discussed the changing healthscape as each population ages.

Consider these values: 6.2% and 17.1%. The former represents the percentage of gross domestic product (GDP) that Taiwan spent on healthcare in 2014 and the latter represents that same spending in the United States. But with a healthcare expenditure that nearly triples that of Taiwan, the U.S. is still seeing a shorter life expectancy and a higher outcome of infant mortality. What is Taiwan doing differently?

Taiwan’s relative success in healthcare may be attributed to their single payer, mandatory social insurance. This healthcare scheme has achieved 99.5% coverage, 80.4% satisfaction, and has low premiums and copayments. Although the current insurance scheme is producing positive outcomes, Chi-Kung Ho, Deputy Minister of the Taiwan Ministry of Health and Welfare and a speaker at the forum, emphasized that population health is the next focus for the country.

Taiwan, along with many countries from South and Southeast Asia, is experiencing a boom in the growth rate for the population aged 65 and over as life expectancy increases. By 2025, Taiwan is expected to move from an “aged” nation to a “super-aged” nation, meaning that more than 20% of the population will be over 65 years old. With the second lowest fertility rate in the world and a medical workforce shortage, Taiwan will have to face the challenge of providing care to the aging population. This same concern over elderly care is on the horizon for the U.S. as the baby boomer generation, the individuals born between 1946 and 1964, continues to age.

Christopher Koller, President of the Milbank Memorial Fund and one of the forum presenters, highlighted long-term care in a conversation about the need for provider payment reform in the U.S. In the case of Massachusetts, almost half of the Medicaid money is going towards long term care and this amount is projected to increase with the aging population.

According to Koller, the U.S. might consider looking at Taiwan to see how their healthcare system addresses the demographic shift in age. It has the opportunity to witness a shift of focus from individual health to population health and can learn important lessons from Taiwan, South Asia and Southeast Asia before it has to implement its own reform.

Rapidly aging populations  is one of the key themes that Innovations in Healthcare will be investigating in our upcoming Southeast Asia Healthcare Landscape Analysis. The analysis will feature spotlights on ASEAN countries, with a particular focus on market gaps and opportunities as population demographics change.   To learn more about this project, contact me at