ABSTRACT
This chapter uses a revised version of the multiple-streams framework to examine the National Health Insurance (NHI) reform in Taiwan. It finds that the process of the NHI reform was protracted. The NHI was technically feasible because policy entrepreneurs learnt from the single-payer system in Canada, and the premium model they proposed had long been used by the government to fund healthcare. It promoted the ideas of redistributive equity, cost containment, and systemic efficiency, which were endorsed by the government and the public, especially the uninsured and those who faced high medical expenses. The ruling party’s full control of the planning and policy decision-making process, its sizable majority in the Legislative Yuan, internal factionalism of the opposition party, and fragmented societal groups facilitated the passage of the NHI Bill. The NHI was finally implemented in 1995. At present, there is a high level of public satisfaction with the NHI. But the problems of an ageing population, insurance coverage for patients with catastrophic illnesses, and the waste of medical resources pose serious challenges to the fiscal sustainability of the NHI system in the long run.
