WHO and Taiwan: the political dilemma hindering progress in global health

It is widely recognized by the international community that health has become an essential human right, with significant universal value. Indeed, everyone knows that better health results in greater well-being for all the inhabitants of a country, which brings about beneficial consequences for the survival and development of a nation, and also for all of us who inhabit the Globe.

During the 77th World Health Assembly, which took place in Geneva between May 27 and June 1, 2024, its members adopted the 14th General Programme of Work of the World Health Organization (WHO) for the period 2025-2028. 

This program basically includes the following strategic objectives: improving coverage of essential health services and enabling the financing of universal health coverage. WHO has urged Member States to take action in this regard.

It should be noted that Taiwan is several years ahead in implementing both objectives. Indeed, the island already developed its National Health Insurance (NHI) in 1995. This system, which unified the already existing labor insurance systems, has reached 30 years and currently covers 99.9% of the population. The NHI system provides equitable, accessible, and efficient medical care to all the people of Taiwan. It is an essential pillar, guaranteeing the island's social stability, as well as the health and safety of its citizens, becoming a global benchmark for achieving universal health coverage. 

In an annual survey conducted by the website Numbeo, Taiwan has ranked first in the Health Care Index for seven consecutive years. This is a successful experience in today's world, where providing health care to all inhabitants has become a challenge and, often, a utopia. Perhaps this is the opportunity for different nations and WHO itself to focus on Taiwan as a reference and learning point to try similar successful solutions.

The NHI system operates with a copayment model when a medical service is received. It is fully self-sustaining, and it has been able to address the financial challenges posed by an aging population and the increase in medical care costs due to growing complexity and technological advances that have made new therapies and services available to the population. By adjusting premiums and adding additional sources of funding, such as the tobacco consumption tax, the system has been established on a solid and sustainable foundation.

The NHI covers the majority of the population and offers medical care with low copayments to prevent abuse of the system. Regular office visits have fixed copayments, of around, for example, US$3.33 (100 NTD – New Taiwan Dollar) per consultation with a general practitioner. If an insured person needs to be hospitalized, a coinsurance will be charged, with the rate varying according to the length of stay. 

Copayment exemptions are allowed for certain groups, such as patients with catastrophic illnesses, childbirth, medical services in mountainous areas or on islands near the coast, low-income households, and veterans. 

The current copayment for emergency care at medical centers is approximately US$26. The NHI covers a wide range of specialties, from acupuncture to dental care. 
The NHI also reimburses health care in the private sector, allowing patients to freely choose the hospitals and doctors they prefer. 

The copayment system seeks to balance accessibility to medical care with the responsible use of resources.

Meanwhile, the government of Taiwan launched in 2024 the vision of "Healthy Taiwan," whose objective is to ensure the good health of the population. This program, which keeps a focus on citizens, families, and communities, aims to expand health promotion actions and preventive medical care. A family doctor plan has also been implemented (something similar to what we call "primary care physicians" in Argentina), offering comprehensive care to patients with chronic diseases and using telemedicine to improve the accessibility of medical care in rural areas. By promoting integrated long-term care, palliative care, and aging at home, Taiwan seeks to guarantee dignified and comprehensive care throughout the entire life cycle for all its citizens, accompanying them in all stages of their existence.

In 2021, WHO developed and published the "Global Strategy on Digital Health 2020-2025", which encourages the adoption of people-centered digital health solutions to prevent, detect, and respond to infectious diseases. It also promotes the development of infrastructure and technological applications in order to leverage citizens' medical data, to promote the health and well-being of the population. 

In both aspects, Taiwan has developed its expertise in information and communications technology to build effective health systems and services, with a high return on investment. The NHI cloud medical system facilitates more efficient exchange of clinical records. It has also adopted international standards in the field, such as "Fast Healthcare Interoperability Resources" (FHIR), which guarantee and improve the international exchange of medical data. 

Additionally, the incorporation of Artificial Intelligence (AI)-assisted technologies in health allows Taiwan to develop smart medical care. The use of the virtual National Health Insurance card and the My Health Bank App allows citizens to efficiently manage and access their personal health data in real time, enabling them to make the treatment or therapy decisions that benefit them most.

In 2008, Taiwan introduced Health Technology Assessment to facilitate the adoption of evidence-based policies and accelerate the inclusion of new treatments in the NHI system. For example, this country has covered new gene and cell therapies since 2023, which has marked a new era for precision medicine, offering patients better treatment options. 

In addition, Taiwan continues to leverage innovative technologies to improve the working environment of various health care professionals, thus strengthening the overall quality of its medical service.

Despite facing arbitrary exclusions and political challenges, Taiwan has participated incessantly in international health affairs, permanently supporting the global health system. So much so that, during the COVID-19 pandemic, this country played a crucial role, sharing supplies, strategies, and experiences, thereby showing that it is a reliable partner for the international community. 

Taiwan's successful history in implementing universal health coverage has been a valuable lesson for the entire world, as well as its financial management systems for the health system and its digital health programs, which can be taken as a reference and foundation by different nations, with Taiwanese cooperation, which will allow them to achieve the goal of universal health coverage put forward by WHO.

In this era of rapid change, in which health challenges transcend borders and global cooperation has become essential to address various health crises, we can't afford to do without any actor in the international arena.

However, Taiwan has been inexplicably prevented from participating in WHO, which is the main global health cooperation body — due to pressure exerted by the People's Republic of China.  This country bases this exclusion on United Nations General Assembly Resolution No. 2758 and WHA Resolution 25.1. However, and paradoxically, neither of these resolutions mentions Taiwan nor declares or recognizes that Taiwan is part of the People's Republic of China, so as to justify such an exclusion and consider that mainland China has the right to represent Taiwan in WHO.

Why not apply, in this case, the essential values of the United Nations of inclusion and universality? Even more so, when it comes to an essential human right, such as health, which all nations should uphold, regardless of their political or ideological beliefs.

Indeed, a higher value is at stake: the well-being of humanity. So, why are WHO and other nations prevented from recognizing and taking advantage of the considerable contributions that Taiwan has made to global public health and the inalienable human right to health?

On matters of health and the well-being of humanity, it is appropriate for an organization like WHO to adopt a more open mindset, under the principles of professionalism and inclusion, for the benefit of its own member states. 

What prevents Taiwan from being included, for practical, humanitarian, ethical, and public health reasons, in the World Health Assembly and in all WHO meetings, activities, and mechanisms, particularly those related to the WHO agreement on the pandemic?

Meanwhile, until sanity and common sense prevail again in WHO, Taiwan must continue to wait patiently to work with the international community, in order to build a future of borderless medical care that fulfills the essential human right to health, stipulated in the WHO Constitution and the vision of leaving no one behind, proclaimed in the United Nations Sustainable Development Goals.