Is An Affordable Healthcare System Always Good?
High cost is the primary reason that prevents Americans from accessing health care services, according to Johonniuss Chemweno. He added that Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or receiving follow-up care has become unaffordable. As long as you are a part of the US healthcare system, you can tell it is poorly designed. However, as someone from Taiwan, a country known for its “almost free” health care, I notice a benign side-effect the US healthcare system brings to the people.
The healthcare system in Taiwan versus in the United States
I would say these two countries are the two sides of the spectrum when it comes to the healthcare system.
The US healthcare system does not provide universal coverage, and not everyone has comprehensive health insurance. In 2021, the number of people covered by health insurance from their employer sits at around 156 million, or 49% of the country’s population, according to eHealth.
On the contrary, according to the authority concerned, 99.9% of Taiwan residents have enrolled in the health insurance provided by the government, and the employers are obliged to cover 60% of employees’ health insurance. Taiwan ranks 13th in the World Index of Healthcare Innovation with an overall score of 49.26. Residents pay almost nothing for necessary clinical healthcare. For these reasons, Taiwan's healthcare is affordable with high quality, which I don’t think is completely true. We’ll get there later.
How could an affordable healthcare system with high quality go wrong?
I can only speak from my personal experience, but based on my observation, the affordability and accessibility of Taiwan’s healthcare lead to people’s abuse. Patients take this privilege for granted. It’s often heard that there are people who go to the doctor without any sickness. People “stock” medicines at home. A lot of people are not taking much attention to their bad living habits that cause bad health issues because the treatment is cheap. Is this quality of healthcare we want? I doubt it.
On the doctor's side, the doctors are often educated to see a lot of patients within a short period to increase “accessibility” (or maybe just to make more money). Patients can make an appointment for a visit on the same day but only get to see a doctor for 30 minutes for a dental visit and 5–10 minutes for other types of visits. You walk into the room, talk about your problems to the doctor within three sentences and get a medication prescription that you don't quite understand why you have to take, and leave. Come back to get maybe the same medicine when it happens again, period. In the United States, to my observation, clinics block at least an hour for your appointment with a thorough checkup. The doctors educate patients on how to prevent the same issue from happening and provide constructive suggestions on building health in the longer term.
Aside from the doctor-patient interaction, the Taiwanese government is in huge debt to provide this so-called affordable healthcare. According to Vox, Americans die prematurely of heart disease and lung cancer at higher rates than the Taiwanese. People in Taiwan live a little longer in general, though there are populations that encounter early deaths from alcohol use and stroke, just as some disadvantaged groups do in the United States. Yet overall, Taiwan spends 6 percent of its GDP on health care, about a third of what the United States does. I can’t help but ask, is it worth it?
Why does this phenomenon happen?
And I think this phenomenon is highly related to the country’s culture. Based on Hofstede’s Six Dimensions Theory, there are six dimensions to evaluate a country’s culture.
Based on the theory, I conducted a comparison between Taiwan and United States as shown in the below graphic, and Taiwan has a higher power distance and uncertainty avoidance than the United States. What that means is people in Taiwan are more likely to follow hierarchical orders and maintain rigid codes of behavior to avoid uncertainty. Without orders and codes of behavior, people feel insecure. Therefore, how this culture reflects in the healthcare system is people go to the doctor even for small problems but they do not know how to take precautions for large health problems when medical experts give no instruction.
For example, the patient goes to the doctor to get medication for a small cough and the doctor prescribes a medicine to alleviate the patient’s cough. However, what if the patient and the doctor both neglect the more important part that the cough is caused by his bad smoking habit, and it could lead to lung cancer in the future? If the doctor spends more time learning about the patient and informs him of how this habit can make not just cause chronic cough but also bad impact on his health, maybe the patient will follow the doctor’s suggestion, quit smoking, and pay more attention on his lung health to prevent the bigger health issue.
If I could redesign the health system for Taiwan, I would…
increase the copayment patients pay out of their pockets and require the doctor to spend more time on the patient.
When you have to pay for something, you simply take more care of everything potentially inducing the cost. When the gas price rises, you think about how to reduce the miles you drive every day. That’s a natural rule.
Conclusion
I have to iterate that Taiwan’s affordable healthcare system provides tons of advantages, and the most beautiful part is you don’t see a health gap between the poor and the rich. However, the system can’t be perfect. And I think having people pay for healthcare is reasonable, and it will increase people’s awareness of their health and do good for them eventually.
