Some health statistics about Taiwan

  • Population

    23.5 million ( as of January 2016)

    Expected life years at birth: 76.7 years for male and 83.2 years for
    female in 2015

    Adult Mortality Rate (Probability of Dying between 15 and 60 years
    per 1,000 population): 94.5 Per 1,000 Population
    Infant mortality rate:
  • Total Fertility Rate 1,175 ‰ (2015)
  • Health Expenditure (Million NT$) 995,544
  • Health Expenditure as % of GDP: 6.19 (2015)
  • The 10 leading causes of death in year 2015:
    Malignant neoplasms
    Diseases of heart (except hypertensive diseases)
    Cerebrovascular diseases
    Diabetes mellitus
    Accidents and adverse effects
    Chronic lower respiratory diseases
    Hypertensive diseases
    Nephritis, nephrotic syndrome and nephrosis
    Chronic liver disease and cirrhosis
  • The number of death due to cancers in year 2015 was 46,829 - that accounts 28.6% of the total numbers of death. The standardized mortality rate is 128.0 per 100,000 population.
  • The 10 leading causes of death in cancer patients (2015):
    Cancers of trachea, bronchus and lung
    Cancers of liver and intrahepatic bile ducts
    Cancers of colon, rectum and anus
    Cancer of breast
    Cancer of oral cavity
    Cancer of prostate
    Cancer of stomach
    Cancer of pancreas
    Cancer of oesophagus
    Cancers of cervix uteri and uterus, part unspecified
  • Smoking rates in adult (2014): 16.4% (men: 29.2%; women: 3.5%).

National Health Insurance

Inherited from the early Laborer's Insurance, Government Employee’s Insurance and Farmer’s Insurance, Taiwan has implemented the National Health Insurance (NHI) since 1995. The NHI in Taiwan is a single payer, compulsory social insurance. The coverage rate has approached near 100% of the population in Taiwan recently since the inmates and military are also included.

Most (93.2%) of the health care facilities in Taiwan are contracted with NHI system, that amounts to 20620 hospitals and health care providers. In additional to these, there are also nearly 6000 pharmacies, over 500 home-nursing care institutions, 200 psychiatric community rehabilitation centers, 15 midwife clinics, 217 medical laboratories, 11 physical therapy clinics, nine medical radiology institutions, two occupational therapy clinics and one respiratory care clinic are also contracted (Source: National Health Insurance Annual Report 2015-2016).

The co-payments under NHI are very low (NT$ 50~450 for an outpatient visit, or up to NT$200 for a prescription, or 5%~30% for an episode of inpatient care); while the scopes of the benefit package of NHI are very wide: inpatient and ambulatory care, dental services, traditional Chinese medicine therapies, child delivery services, physical rehabilitation, home care, and chronic mental illness care, etc. These care include general diagnoses and treatment, medical consultations and operations, and related expenses such as examinations, laboratory tests, anesthesia, prescription medications, supplies, nursing care, hospital rooms, and certain OTC drugs. (Source: National Health Insurance Annual Report 2015-2016).

Geographic location of health care claims will be broadly classified into 6 regions in Taiwan. Salary range, which serves as the basis for enrollees’ premium calculation, can serve as a proxy indicator for socioeconomic status. Unlike many health insurance claims data in North America, over-the-counter medications are reimbursed and captured in NHI. Bundled payment according to the diagnosis-related group system only apply in limited number of disease conditions, therefore detailed drug use information during hospitalization is also available. An added advantage of the NHI data source is the low membership turnover rate, which is particularly important for long-term follow-up study.

The information system was carefully designed to facilitate the efficiency and validity of the claims information. The health insurance IC card, which was introduced in 2004, has built up a model for the adaptation of technology to facilitate the information exchange. In recent years, the National Health Insurance Administration (NHIA) has made a lot of efforts to ensure the quality and the speed of the claims records, as well as the confidentiality and privacy of the patient information.

Selected publications

As Dr. Ann W. Hsing incisively summarized in her article in JAMA Internal Medicine 2015, “the large and longitudinal nature of the [NHI claims] data permits a wide range of study design.” Indeed, many good research has been conducted and reported with the benefit of longitudinal health data for over a decade.

Here are some selected publications based on the large linked electronic healthcare databases in Taiwan.

Drug safety study

Medical device or procedures

  • Chang, C.H., et al., Effect of radiofrequency catheter ablation for atrial fibrillation on morbidity and mortality: a nationwide cohort study and propensity score analysis. Circ Arrhythm Electrophysiol, 2014. 7(1): p. 76-82.
  • Chang, C.H., et al., Effectiveness and safety of extracranial carotid stent placement: a nationwide self-controlled case-series study. J Formos Med Assoc, 2015. 114(3): p. 274-81.

Comparative effectiveness

Development of a pharmacy-based comorbidity index

  • Dong, Y.H., et al., Development and validation of a pharmacy-based comorbidity measure in a population-based automated health care database. Pharmacotherapy, 2013. 33(2): p. 126-36.

National program evaluation

  • Chang, C.H., et al., National antiviral treatment program and the incidence of hepatocellular carcinoma and associated mortality in Taiwan: a preliminary report. Med Care, 2013. 51(10): p. 908-13.