Lending a Helping Hand: The Impact of Constitutional Interpretation on Taiwan's National Health Insurance Program, Health Equity, and Distributive Justice
Colleen M. Flood & Aeyal Gross, eds., The Right to Health at the Public/Private Divide: A Global Comparative Study (New York: Cambridge University Press, 2014) 236
42 Pages Posted: 13 Apr 2014 Last revised: 29 Apr 2014
Date Written: December 1, 2013
Taiwan's National Health Insurance (NHI) program is by design a compulsory social insurance scheme financed predominantly by a progressive payroll tax. Since its introduction in 1995, the NHI has managed to reduce the number of individuals without health insurance from 41 percent to less than one percent. Studies have also shown that the NHI has had some successes in reallocating health resources from the rich to the poor. This chapter examines the role of Taiwan's Constitutional Court in shaping the NHI and therefore contributing to improved health equity. In contrast to the general perception that the pursuit of human rights is individualistic in nature, this chapter describes a series of constitutional interpretations in which the Taiwanese Court relied on collectivist values such as mutual support, risk sharing and vertical equity to uphold the NHI's compulsory enrolment policy, the practice of calculating NHI insurance premiums based on certain presumed minimum income, and the right of the government to limit the scope of the NHI benefit basket. It is argued that the Constitutional Court in these cases not only managed to protect the collective vision of the NHI from individual attacks, but it also enhanced the NHI's progressivity by ensuring that underprivileged beneficiaries have the right to receive proper government assistance with meeting their insurance premium obligations. Ultimately, however, the Court came short of proclaiming a constitutional right to health, and as a result it has limited further progress with respect to health equity in Taiwan. This chapter concludes by urging the Constitutional Court to pay heed to the International Covenant on Economic, Social and Cultural Rights, which recently receives domestic legal status in Taiwan, and to recognize a robust constitutional right to health so as to facilitate Taiwanese people's equitable access to both medical care and underlying social determinants of health.
Keywords: Taiwan, National Health Insurance, constitutional law, right to health
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