Taiwan’s National Health Insurance (NHI), now in its 30th year, is internationally recognized for achieving universal coverage, providing comprehensive, low-cost, and accessible care to more than 99% of the population. Its strong digital infrastructure—most notably the smart card system—proved instrumental during the COVID-19 pandemic, significantly enhancing the program’s effectiveness.

Yet alongside these achievements, the NHI faces pressing challenges in financial sustainability and care delivery. Taiwan’s rapidly aging population, combined with the emergence of new medical technologies and therapeutics, has heightened public expectations and demand for better care, further straining the system’s finances. Over three decades, stringent expenditure controls have helped contain costs but at the expense of workforce adequacy, timely adoption of innovations, and quality management of chronic diseases.

Future reforms will inevitably need to focus on raising premiums, diversifying funding sources, and optimizing healthcare delivery to balance quality with sustainability. The core dilemma, however, lies in how public finance instruments can be leveraged to ensure adequate and sustainable funding to meet the population’s growing healthcare needs. Paradoxically, the NHI’s consistently high public approval rating—hovering around 90% in recent years—may make substantive reform politically more difficult if not impossible.

Taiwan’s experience offers important lessons for other countries. First, strong political commitment is essential for both the establishment and ongoing success of universal health coverage. Second, robust information technology infrastructure is critical to efficiency. Third, there is no “free lunch”: in a system like Taiwan’s, where health expenditure is kept at a relatively low at 7% of GDP, stringent cost controls inevitably carry serious adverse consequences. Finally, Taiwan demonstrates that even the most celebrated and popular systems face continual challenges, reforms are rarely straightforward, and long-term sustainability can never be taken for granted.

Hongjen Chang is the current Chairman and CEO of YFY Biotech Management Co., in addition to serving as the Chairperson for several other private biotech firms. Before joining the YFY Group—which has grown from a paper mill into a conglomerate with interests in electronics, finance, biotech, and agriculture—Dr. Chang dedicated over 16 years to Taiwan’s Health Ministry. From 2005 to 2021, he also led Taiwan Global BioFund as its CEO. Widely recognized in Taiwan for his extensive public health administration experience, Dr. Chang is credited with implementing the smart card program during his time as President and CEO of BNHI, the country’s universal health care institution. This initiative was crucial to Taiwan's early success in containing the COVID-19 pandemic in 2020. Dr. Chang holds a medical degree from National Yang-Ming Medical College, an M.S. in Public Health from National Taiwan University, and an M.S. in Health Policy and Management from Harvard School of Public Health.