When we go to the dentist, we are used to paying for the appointment through a private insurance company or out-of-pocket. Government-funded programs do exist, but their scope is relatively limited. Other places in the world have different models to pay for various health care services. Once such model is national health insurance (NHI), which is implemented in my home country of Taiwan.
How does national health insurance work?
National insurance is similar to what Medicaid and Medicare are in the United States, yet it applies benefits to all citizens and does not strictly set eligibility requirements to age or income. To understand how it works, picture a treasure chest. All citizens contribute to the treasure in the form of taxes. People can dip into the treasure for certain visits to the doctor’s office. For example, routine dental cleaning is covered under national health insurance. Patients report to the front desk and hand in their national health insurance card. This card documents how much to reimburse the dentist, and the patient pays for the remaining fee, if any.
The NHI covers both medical and dental benefits under certain rules. Patients are covered for scaling once every six months. Other procedures with some coverage include fillings, local anesthetics, endodontic treatments and extractions.
What changes have been made to the NHI?
In 2012, pit-and-fissure sealants were added to the NHI. All first graders qualify, as well as second graders from low socioeconomic backgrounds. These include low-income, rural and disabled children. The NHI specifies free sealants placed on all four permanent first molars, an oral exam and oral hygiene instructions in the same appointment. A recall appointment follows within six to 12 months.
Fluoride varnishes are included in a similar vein. Patients under six years old are covered once a year, and disadvantaged patients under 12 qualify for three times a year.
Why does NHI matter?
There are various models for health care systems around the world. While no model is perfect, it is helpful to get a glimpse into how people receive and pay for health care so that we as dental students and advocates for our patients can understand what works and what doesn’t. When changes are made to these models, it impacts all aspects of society, specifically access to care on the patient side and reimbursement levels on the provider side.
There are also many questions to explore. With regard to NHI, many may wonder, will the program bankrupt itself? Or does it promote prevention, thereby reducing medical costs down the line? Coverage for sealants and fluoride varnishes is a good example. What is the likelihood that cheaper preventative measures increase people’s awareness of dental hygiene? What are the chances that people are seeing the dentist at an earlier age than they would have otherwise? What does the government say in its public health messaging in promoting preventative care? These are the factors at play in the cost-benefit analysis of NHI.
These are not easy questions to answer, and they remain as long as NHI exists. But whenever a conversation over NHI does resurface, it communicates at least one clear message: that the people of Taiwan care about their health and how it gets paid.
~Ryan Lee, Texas-Houston ’23, ASDA Contributing Editor