Taiwan’s National Health Insurance (NHI) system is known for its high accessibility and low barriers to care. However, inexpensive healthcare does not mean that healthcare costs do not exist; rather, these costs are absorbed by the healthcare system through its institutional design. Taiwan operates under a global budget payment system, in which the government sets an overall healthcare budget in advance. Healthcare providers then claim NHI points based on the services they provide, while the monetary value of each point is calculated retrospectively according to the global budget and total points claimed. When healthcare utilization increases and total claims exceed the available budget, the value of each point may fall below NT$1, requiring healthcare providers to collectively absorb reductions in reimbursement. In recent years, hospital-sector point values have generally ranged from 0.85 to 1, while outpatient dialysis point values have ranged from approximately 0.92 to 0.97. In 2023, Taiwan’s current healthcare expenditure accounted for 7.2% of GDP, lower than the OECD average of 9.2% and Japan’s 11.5%. This demonstrates Taiwan’s ability to maintain highly accessible healthcare with relatively limited overall spending, but at the cost of shifting greater financial pressure onto healthcare providers.
Although Japan also uses a point-based system to price medical services, its point value is fixed at JPY 10 per point. Medical service fees are generally reviewed every two years, with the government periodically adjusting reimbursement rates rather than allowing point values to fluctuate retrospectively with overall healthcare utilization. Taiwan can therefore be characterized as using a “retrospectively determined, variable price,” under which increased healthcare utilization may lead services within the same global budget to collectively bear lower reimbursement. Japan, by contrast, uses a “predetermined, fixed price,” providing healthcare institutions with greater predictability in revenue while addressing expenditure pressures primarily through government adjustments to medical fees and public financing.
The two systems also differ in how they allocate the financial risks associated with serious illnesses. Japan operates the High-Cost Medical Expense Benefit system, which sets monthly out-of-pocket payment ceilings according to income, thereby limiting patients’ financial exposure even when medical expenses are substantial. Taiwan provides broad coverage for essential healthcare services, but patients may still face significant out-of-pocket expenses for certain new drugs, advanced medical devices, and specific treatments. Budget constraints may also affect the speed at which innovative medicines are included under NHI reimbursement. In Japan, newly approved drugs are generally listed for reimbursement within 60 days, or within 90 days at the latest. In Taiwan, patient groups and media reports have frequently noted that reimbursement decisions for some cancer and innovative medicines can take more than 700 days.
The fundamental difference between the two systems, therefore, is not simply the price of healthcare, but who bears the risk. Through its global budget system, Taiwan internalizes a greater share of financial risk within the healthcare delivery system, potentially resulting in declining point values, compressed reimbursement, and relatively unfavorable conditions for high-cost and high-risk medical services. Japan, meanwhile, uses fixed prices and caps on patients’ out-of-pocket payments to shift a greater share of high-cost medical risk to the government and insurance system. Japan nevertheless faces its own pressures, including population aging, growing public expenditure, healthcare workforce shortages, and regional disparities in access to care. Neither system can escape the reality of limited resources. The key distinction lies in who—healthcare providers, patients, or public finances—is expected to bear the burden first when healthcare demand continues to rise and the system approaches its resource limits.
【2026-08-17/udn】
