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Presentation on theme: "Unless noted, the course materials are licensed under Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Taiwan (CC BY-NC-SA 3.0)Creative Commons."— Presentation transcript:

1 Unless noted, the course materials are licensed under Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Taiwan (CC BY-NC-SA 3.0)Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Taiwan (CC BY-NC-SA 3.0)

2  Introducing myself  Do you know how to ask questions and read numbers  Basic concept of health care – examples  International Criteria of a good health care system  The performance of Taiwan’s NHI

3  Graduate of Yang Ming Medical School, NTU School of Public Health and HSPH  Joined the Government for 16 years before change career as Biotech Venture Capitalist  Head of DOH’s IT Department, Founding DG of CDC, Head of BNHI……  Teaches at YMU, “Case Studies in Health Policy”, on top of my job as an investor.

4 "The average citizen pays 20 U.S. dollars per person, per month." "They can go to any doctor, any hospital they want. They pay, on the average, two U.S. dollars and a maximum of about 10 U.S. dollars each visit. And we don't have a waiting list." Hong-jen Chang, ABC News October 25, 2003

5 Biodiscover

6 石曜堂

7 Money or Life? Bridging cultural differences for a sustainable Health care system

8 Meiji Ishin heralded the introduction of modern health care system to Asia Otto Von Bismarck 1815-1898

9 楢山節考 Narayama Bushiko ( 1983 今村昌平 ) Money or Life?

10  “the custom, harshly implacable to Occidental eyes, of transporting the aged and infirm rustic villagers to the barren heights of Mount Narayama, where a rough nature soon solves the problem of feeding and maintaining them. In the Japan of long ago………, the approach to the geriatric enigma was drastic but simple. “ The New York Times, June 20, 1961

11 11 Conclusions: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs. (N Engl J Med 1997;337:1052-7.)

12  How to valuate Life ？  The Black and White Pill 12 Wikimedia PHenry

13 13 SUPPOSE A PERSON FACES A HAZARD THAT WILL KILL HIM OR HER WITH PROBABILITY “P”, IF HE SURVIES, HE WILL LIVE HIS NORMAL LIFE WITH WHATEVER WEALTH HE POSSESSES. HOWEVER, SOMEONE ARRIVES WITH A WHITE PILL THAT IF TAKEN WILL SURELY ELIMINATE THE DEATH RISK FROM THIS HAZARD. HOW MUCH “X” WOULD THE INDIVIDUAL BE WILLING TO PAY FOR THE WHITE PILL? (B) THE WHITE PILL EXPERIMENT FUTURE LIFE LOTTERY O O O O BUY WHITE PILL REFUSE WHITE PILL (WEALTH W - X) (WEALTH W) FUTURE LIFE LOTTERY LIVE (WEALTH W) NODE (WEALTH W) DIE HongJen Chang

14 14 10 -9 10 -8 10 -7 10 -6 10 -5 10 -4 10 -3 10 -2 10 -1 10 0 1 10 10 2 10 3 10 4 10 5 10 6 10 7 10 8 P MAX ＝ 0.10 PROBABILITY OF DEATH (HOWARD) AN ILLUSTATIVE RESULT (BLACK PILL) $X$X HongJen Chang

15 15 (A) THE BLACK PILL EXPERIMENT A PERSON IS OFFERED THE CHANCE TO TAKE A PILL THAT WILL KILL HIM INSTANTLY AND PAINLESSLY WITH PROBABILITY “P”, IF HE TAKES THE PILL, HE WILL RECEIVE $X. SHOULD HE ACCEPT? FOR EXAMPLE, SHOULD THE PERSON ACCEPT A P = 1/10,000 INCREMENTAL CHANCE OF DEATH FOR A PAYMENT OF $1,000? O O O O REJECT BLACK PILL ACCEPT BLACK PILL (WEALTH W) (WEALTH W + $X) FUTURE LIFE LOTTERY LIVE (WEALTH W + $X) P FUTURE LIFE LOTTERY I - P DIE HongJen Chang

16 16 PROBABILITY OF DEATH (HOWARD) $X$X 10 -9 10 -8 10 -7 10 -6 10 -5 10 -4 10 -3 10 -2 10 -1 10 0 1 10 10 2 10 3 10 4 10 5 10 6 10 7 AN ILLUSTATIVE RESULT (WHITE PILL) V e = “ECONOMI C VALUE OF LIFE” HongJen Chang

17  Under 3: 20%  3-69: 30%  70 and above: 10% (high income 20%) › Younger senior (70-74) › Elder senior (75 and above)

18  2006: Senior citizen (> 70) with annual income above 6.3 million Yen, › copayment rate 20%  30%  2008: 70-74 10 %  20%  2008 – 20% copayment extend to preschool from the previous under 3

19 … Japan has dealt with financing constraints in light of its stagnating economy. In addition to gradual restructuring, co-pays and premiums have increased significantly. Workers who had no co-payment twenty years ago now are responsible for 30% of their medical fees.

20 And we proudly announce the 50 million uninsured! ehbs.kff.org

21 BBC

22 The NHS fails its own bewilderingly complicated health check The Economist, Oct. 2006 www.economist.com

23 23

24  Good health is to a great extent the responsibility of the individual. The Ministry also plays a key role in reducing illness in Singapore through the control and prevention of diseases and ensuring that the resources are allocated appropriately to do this  Ensuring Singaporeans have access to good and affordable healthcare that is appropriate to needs while emphasize the principle of co-payment.

25  A three tier system with MSA, Deductibles, and limited benefit catastrophic insurance covering urban workers  125 cities > 1 million by 2010 Wikimedia Shizhao

26 Copyright ©2008 by Project HOPE, all rights reserved. Winnie Yip and Ajay Mahal, The Health Care Systems Of China And India: Performance And Future Challenges, Health Affairs, Vol 27, Issue 4, 921-932 26 Health Affairs

27 Copyright ©2008 by Project HOPE, all rights reserved. Winnie Yip and William C. Hsiao, The Chinese Health System At A Crossroads, Health Affairs, Vol 27, Issue 2, 460-468 27 Health Affairs

28 Health Spending and Health Status Indicators in Selected OECD Countries and Taiwan, 2004 Countries Total health spending as % of GDP Total health spending per person (US$ PPP) Life expectancy at birth (years) Infant mortality rate (per 1,000 live births) Taiwan 6.261,44076.42.9 Japan 8.0**2,249*82.12.8 Czech Republic 7.31,36175.83.7 Poland 6.580575.04.2 Germany 10.9*3,005**78.66.8 U. K. 8.32,54677.8*5.1 United States 15.36,10276.8*6.9** *2000 figures **2003 figures HongJen Chang

29 29 資料來源 : 1. OECD Health Data,2000~2002 2. 行政院衛生署編印之中華民國 89 年衛生統計動向 3. International Health Policy 之 Chart VIII-5 from Multinational Comparisons of Health System Data,2000 HongJen Chang

30 30 資料來源 : 1. OECD Health Data,2000~2002 2. 行政院衛生署編印之中華民國 89 年衛生統計動向, 主計處 91 年 8 月 13 日國情統計通報專題分析 3. International Health Policy 之 Chart VIII-1 from Multinational Comparisons of Health System Data,2000 US Dollars HongJen Chang

31 31 US Dollar 資料來源 : 1. OECD Health Data,2000~2001 2. 行政院衛生署編印之中華民國 89 年衛生統計動向, 主計處 91 年 8 月 13 日國情統計通報專題分析 3. International Health Policy 之 Chart VIII-9 from Multinational Comparisons of Health System Data,2000 HongJen Chang

32 32 資料來源 : 1. OECD Health Data,2000~2001 2. 行政院衛生署編印之中華民國 89 年衛生統計動向, 主計處 91 年 8 月 13 日國情統計通報專題分析 3. International Health Policy 之 Chart VIII-9 from Multinational Comparisons of Health System Data,2000 No. of visit HongJen Chang

33 33 資料來源 : 1. OECD Health Data, 2000~2001 2. 行政院衛生署編印之中華民國 89 年衛生統計動向, 主計處 91 年 8 月 13 日國情統計通報專題分析 3. International Health Policy 之 Chart VIII-9 from Multinational Comparisons of Health System Data,2000 US Dollar HongJen Chang

34  Evaluation of Health System › Overall level of Health › Distribution of Health in the population › Overall level of responsiveness › Distribution of responsiveness › Distribution of financial contribution

35 Quality: Better Health through better care Access to care Responsiveness: Satisfaction Health care spending: affordability and sustainable financing Efficiency: value for money 35

36  Universality  Accessibility  Affordability  Sustainable Financing  Responsiveness  Equity  Efficiency  Public Satisfaction 36

37 37 Labor Insurance Medical benefits Gov’t Employee Insurance Medical benefits Farmer Insurance Medical benefits Other insurance programs Medical benefits Uninsured (40%) National Health Insurance (99% of population) 1995 HongJen Chang

38 38 Insured BEFORE NHI AFTER NHI Uninsured (8.6 million) Insured d Uninsured 1.33% 98.67% 41% 59% HongJen Chang

39  註 記 內 容 ：重要檢查及藥品處方登錄、各項就醫紀錄登 錄、重大傷病登錄、器官捐贈或安寧緩和醫 療意願登錄等。  使用率監控：透過檔案分析，對於高利用率案件進行管理。  傳染性疾病追蹤： H1N1 、 SARS 39 1234 5678 9012 89/12/31 B123456789 楊志良 HongJen Chang

40

41 41 (1995 ～ 2004) Satisfied (DOH) Satisfied (BNHI) Dissatisfied (DOH) Dissatisfied (BNHI) 1995/5 1995/9 1996/6 1998/1 1998/4 1998/11 1999/5 2000/3 2000/10 2001/6 2001/12 2002/5 2002/8 2002/11 2003/7 2004/4 HongJen Chang

42 42 Public satisfaction with the health system according to WHO criteria HongJen Chang

43 43 HongJen Chang

44  Universality: 99%  Accessibility: Free Choice  Affordability: Inexpensive.  Equity: Fairer but …  Sustainable Financing: WTP?  Responsiveness: Fair  Efficiency: High (Hospitals, BNHI)  Public Satisfaction: High (too high ?) 44

45  Single-payer system  Competitive market on the health care delivery side  Information technology offers additional cutting edge management tool for NHI › 100% electronic claim processing › smart card  Strong generic pharmaceutical industry  Family support  Diligent health care workers 45

46  Cost pressure from aging of the population and introduction of new medicine and technology  Doctor shopping and over prescription resulting in duplication and waste is an increasing public concern  Demand for health care outstrips our willingness to pay  Political pressure  To privatize the BNHI and/or to introduce multi-payer system  Hospitals and doctors are increasing dis- satisfied in the system 46

47 47 Wikimedia Martin Belam

48 PAGEWORKLICENSE AUTHOR/SOURCE 5 This work is from: http://www2.biodiscover.com/news/healthcare/article/82231.h tml, and used subject to http://www.biodiscover.com/agreement.html http://www2.biodiscover.com/news/healthcare/article/82231.h tml http://www.biodiscover.com/agreement.html This work is used subject to the fair use doctrine of Article 52, 65 Taiwan Copyright Act by GET. 2012/8/10 visited 6 This work is from 石曜堂, 《醫療爭議審議報導系列 45 》, p6, Bureau of National Health Insurance, 2010.3. and used subject to the fair use doctrine of the Taiwan Copyright Act Article 50 by GET 8 Wikipedia Evert A. Duykinck http://zh.wikipedia.org/wiki/File:Otto_von_Bismarck.JPG 8 Wikimedia commons Geographicus Rare Antique Maps http://commons.wikimedia.org/wiki/File:1781_Japanese_Temm ei_1_Manuscript_Map_of_Taiwan_and_the_Ryukyu_Dominion_- _Geographicus_-_TaiwanRyukyu-unknown-1781.jpg 9 This 楢山節考 movie poster is from: http://www.cinemaffiche.com/recherche.php?langue=en&jour s=0&ligne1=2&ligne2=2&page=1&lettre=B&motifhttp://www.cinemaffiche.com/recherche.php?langue=en&jour s=0&ligne1=2&ligne2=2&page=1&lettre=B&motif= This work is used subject to the fair use doctrine of Article 52, 65 Taiwan Copyright Act by GET. 2012/8/10 visited 12 Wikimedia commons PHenry http://commons.wikimedia.org/wiki/File:PharmacistsMortar.svg 13 National YangMing University Hongjen Chang

49 PAGEWORKLICENSE AUTHOR/SOURCE 14 National YangMing University Hongjen Chang 15 National YangMing University Hongjen Chang 16 National YangMing University Hongjen Chang 20 Kaiser/Hret 2003 Survey and CNN/money calculations http://money.cnn.com/2003/09/09/pf/insurance/emplo yerhealthplans/http://money.cnn.com/2003/09/09/pf/insurance/emplo yerhealthplans/ This work is used subject to the fair use doctrine of Article 52, 65 Taiwan Copyright Act by GET. 2012/8/10 visited 21 BBC Election2010 http://news.bbc.co.uk/2/hi/uk_news/politics/election_2 010/parties_and_issues/8645845.stmhttp://news.bbc.co.uk/2/hi/uk_news/politics/election_2 010/parties_and_issues/8645845.stm This work is used subject to http://www.bbc.co.uk/terms/personal.shtml#11 3.2/3.2.3 (i) 2012/8/10 visited 22 The Economist, Oct. 2006 This work is used subject to the fair use doctrine of Article 52, 65 Taiwan Copyright Act by GET. 2012/8/10 visited 25 Wikimedia commons Shizhao http://commons.wikimedia.org/wiki/File:Wumen.jpg

50 PAGEWORKLICENSE AUTHOR/SOURCE 26 Winnie Yip and Ajay Mahal, The Health Care Systems Of China And India: Performance And Future Challenges, Health Affairs, Vol 27, Issue 4, 921-932 27 Winnie Yip and William C. Hsiao, The Chinese Health System At A Crossroads, Health Affairs, Vol 27, Issue 2, 460-468 Copyright ©2008 by Project HOPE, all rights reserved. 28 National YangMing University Hongjen Chang 可能需要來源！ 29 National YangMing University Hongjen Chang 30 National YangMing University Hongjen Chang 31 National YangMing University Hongjen Chang 32 National YangMing University Hongjen Chang 33 National YangMing University Hongjen Chang 37 National YangMing University Hongjen Chang

51 PAGEWORKLICENSE AUTHOR/SOURCE 38 National YangMing University Hongjen Chang 39 National YangMing University Hongjen Chang 40 National YangMing University Hongjen Chang 資料來源？ (“ 應該 ” 是老師自己畫的，從全民健保資料庫弄來 的 @@) 41 National YangMing University Hongjen Chang 資料來源？ 42 National YangMing University Hongjen Chang 資料來源？ 43 National YangMing University Hongjen Chang 資料來源？ 47 Wikimedia Commons http://commons.wikimedia.org/wiki/File:Lighthouse_at_ night,_Chania.jpg

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