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Since I realize that a CQ article and a PBS documentary may not count as an academic source in some quarters, I did some reading on Taiwan. Health Affairs recently had a package on the country's experiences, including an article by Jui-Fen Rachel Lu and William C. Hsiao that asked "Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan." They conclude:
Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.In other words, Taiwan was able to move from 60 percent insured to nearly 100 percent insured (a tiny number of folks are overseas or off the grid) without increasing costs at all. Reducing administrative costs, transaction fees, cost shifting, overuse, and so forth paid for the expansion. Since then, they've been able to keep their cost growth low. In addition, "Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the public’s satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs." And they accomplished all this by moving to one of those awful, inefficient, government-controlled single payer programs.Not too shabby.
