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Daily Archives: December 10, 2015

High-income countries South-East Asia

Single-payer, mandatory health insurance in Taiwan

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Jui-fen Rachel Lu, of Chang Gung University in Taiwan, wrote an assessment of her territory’s progress towards universal health coverage for GNHE.

You can read the full assessment here.


The author’s main conclusions are:

  • National Health Insurance (NHI) is one of the most highly rated social programmes in the history of Taiwan, with consistently more than 70% of the public expressing satisfaction with the programme in 2014
  • Since its inception in 1995, NHI has greatly improved access to care and successfully provided financial protection to all citizens of Taiwan
  • It has delivered broadly satisfactory results in terms of the equity of both the financing and delivery of care
  • In general, NHI has been able to shield needy patients from financial barriers to access and provided access to comprehensive care
  • To a great extent the public has enjoyed freedom of choice and convenient access to services
  • Despite its popularity, NHI has constantly been plagued by the threat of financial insolvency
  • The issue of financial sustainability is always top of the reform agenda and there have been numerous reform proposals
  • Unfortunately, unwieldy political processes have prevented the Ministry of Health and Welfare from undertaking reforms to tackle the deficiencies of the system
  • In its 18-year history, the National Health Insurance Administration has only succeeded in raising the premium contribution rate three times, and this came at a high political price, with a Minister of Health having to step down at one point
  • Without fundamental reforms to NHI’s financing mechanism, such as linking premiums to better measures of total household income, the rapidly ageing population and economic stagnation are likely to threaten the financial soundness of the programme
  • For the foreseeable future, financial sustainability will remain a formidable challenge to the single-payer health insurance program in Taiwan


Lu JR. 2014. Universal health coverage assessment: Taiwan. Global Network for Health Equity (GNHE). Available at:

Africa Low-income countries

Achieving universal health coverage in Uganda

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Zikusooka , Kwesiga, Lagony and Abewe, of HealthNet Consult in Uganda, wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ main conclusions are:

  • Tax-based funds contribute a relatively small share of total health financing in Uganda
  • The public sector is heavily constrained in providing an adequate range and quality of services
  • The Uganda population reverts to seeking care from the large private sector, which is perceived to have better quality services
  • The fact that patients have to pay on an out-of-pocket basis for private care intensifies the exposure to financial risk across the population
  • With very limited financial protection and highly fragmented risk pools, there is very little income and risk cross-subsidisation in Uganda
  • As a consequence, utilisation of health care services is largely dependent on the ability to pay rather than need
  • Furthermore, purchasing arrangements do not encourage efficient, high-quality service provision or the provision of services that meet patients’ needs
  • To address some of these problems, the country needs to utilise the current mechanisms put in place to ensure donor assistance is more useful by increasing its effectiveness and equity.
  • The prospects of increasing health resources through the budget seem to be dwindling as the health sector has been crowded out by other government priorities, particularly infrastructural development and the education sector
  • Leveraging other sector-specific resources through implementing mandatory health insurance is thus an area where Uganda should look to increase public sector health resources (Uganda is still considering this policy option)
  • As has been done in other countries in Africa, Uganda could also look at tax levies earmarked for the health sector
  • Finally, wastage is a major issue in use of health sector resources. Making better use of existing resources would require government to institute mechanisms for monitoring and incentivising efficient performance



Zikusooka CM , Kwesiga B, Lagony S, Abewe C. 2014. Universal health coverage assessment: Uganda. Global Network for Health Equity (GNHE). Available at: