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Hospitals Evolution
Under Manchu rule (1683-1895), Taiwan was ravaged by disease. Today,
Taiwan has transformed itself into a population of more than twenty million people
with universally accessible quality health care. In 2000, the Economist magazine
ranked Taiwan second in the world in healthcare quality among advanced and newly
industrialized countries after Sweden. Taiwan's National Health Insurance program
is a rare example of successful implementation of a universal healthcare system,
which ABC News described as a "health utopia". Successful governmental intervention
in medical policy has greatly contributed to Taiwan's public health achievements.
The following sections provide a brief description of the history of the development
of healthcare in Taiwan.
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Taiwan's healthcare system before 1865:
Unstable period
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◆ Dr. James Laidaw Maxwell |
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The historical beginnings of a healthcare system in Taiwan remain unclear. Before
1865, Taiwan was ravaged by diseases including plague, typhoid fever, dysentery,
cholera, smallpox, infectious epidemic meningitis and malaria which were attributed
to its subtropical climate and lack of development of infrastructure or governmental
initiative to control these problems. Opium-smoking was also responsible for
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high mortality rates. In 1885, Liu Ming-chuan became the first governor of Taiwan
and set up a state-run medical bureau and a pharmaceutical bureau in Taipei for
its residents and the soldiers. This marked the beginning of the idea of a state-run
hospital. Unfortunately, due to the lack of financial support, the two bureaus were
forced to close in the following year. The development of Taiwan's healthcare remained
unstable before Christian missionaries ushered in western style medical practice.
The beginning of modern healthcare from 1865 to 1895:
Medical missionaries
In 1865, Dr. James L. Maxwell, the first British
Presbyterian missionary in Taiwan, traveled to southern Taiwan to fulfill his mission
of providing medical services to the people. He brought modern western medicine
to Taiwan. With his help and that of other medical missionaries, Taiwan was able
to begin modernization of the medical profession. After the arrival of Dr. Maxwell
and before the invasion by Japan, the Canadian Presbyterian Church sent several
physician missionaries to Taiwan. Among them, Dr. George L. Mackay in northern Taiwan
and Dr. David Lansborough in central Taiwan are the most distinguished examples.
In southern Taiwan, Gu Lau Hospital(now Sinlau Hospital) was established in 1865.
In northern Taiwan, Mackay Hospital(now Mackay Memorial Hospital in Danshui) was
established in 1873. In central Taiwan, Changhua Christian Hospital started to provide
medical services in 1895. These were the three major hospitals during the Japanese
occupation of Taiwan. In order to care for more patients, Dr. Maxwell accepted students
for training in basic medical knowledge and skills, and used his students to help
him with the heavy medical load. His work is considered to represent the beginnings
of medical education in Taiwan.
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◆ Dr. George L. Mackay |
◆ Dr. David Landsborough |
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Healthcare in Taiwan under the Japanese occupation from 1895 to 1945
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In order to attract more immigrants from Japan, the government of Japan developed
a medical and health infrastructure to help newcomers deal with the special climate,
environment, and diseases in Taiwan. In June 1895, the Great Japan Hospital in Taiwan
(now National Taiwan University
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◆ Sin Lau Hospital in Taiwan, 1932
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Hospital)was established in Taipei. During the 50 years of Japanese occupation,
Taiwan began to develop its own medical profession. Health administrative systems,
state-run hospitals and educational institutes were organized, medical research
began to prosper, public hygiene and disease prevention were greatly improved, systematic
efforts were made to control contagious diseases, and opium-smoking was prohibited.
These achievements laid solid foundations for Taiwan's modern medical development.
During this period, the population in Taiwan increased from 2.7 million to 6.7 million.
The development of medical infrastructure and public health development are considered
an important reason for the rapid population growth which occurred during this period.
By the time Taiwan was returned from occupation by the government of Japan, there
was one university-affiliated hospital,11state-run hospitals, a health care center,
5sea port quarantine stations, 8 women's hospitals, 216 malaria prevention centers,
a smorking control center and more than 50 isolation wards.
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1. The rehabilitation period after the Second World War from 1945 to 1971:
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The turmoil caused by the war stagnated Taiwan's medical development. Large-scale,
well equipped hospitals were still something of a rarity. National Taiwan University
Hospital, Tri-Service General Hospital and Veterans General Hospital (the latter
two were from China), were the three major hospitals in Taiwan at during this period.
Together, these three hospitals led Taiwan's medical research and development during
the rehabilitation period. Provincial hospitals in local cities and counties (now
under the control of the Department of Health) also provided medical care for the
public.
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◆ Taipei Veterans General Hospital
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◆ National Taiwan University Hospital |
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2. The period of prosperity from 1972 to 1994:
Taiwan was forced to leave the United Nations (UN) in 1971 when China usurped its
seat in the UN. This loss was a major blow to Taiwan, which had long been dependent
on related aid from the United States. Nevertheless its people responded to this
adversity and Taiwan was able to turn the crisis into an opportunity, and create
an economic miracle in the following 20 years. This period saw dramatic improvement
in medical infrastructure, with the construction of many large and small hospitals
which provided residents with Sin Lau Hospital in Taiwan, 1932 National Taiwan University
Hospital Taipei Veterans General Hospital an increasing variety of medical care
choices and services. The number of hospitals on the island more than doubled during
this period. In 1971, the central government assumed responsibility for the highest
administrative level decisions for healthcare institutions and policy, and the Department
of Health under the Executive Yuan was officially established.
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◆ Kuang Tien General Hospital in Taiwan, 1956
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3. The period of the National Health Insurance program from 1995 to present:
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A variety of social and medical insurance plans were used to help provide access
to healthcare preceded the NHI program, such as Workers' Insurance, Government Officials'
Insurance and Farmers' and Fishermen's Insurance, but coverage rates did not reach
60% of the population. In 1995, the various types of government run insurance programs
were officially integrated and Taiwan's NHI program was
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◆ Since Augues 1975, Chung-Te Primary School in Chung-Te Village, Sioulin Township,
Hualien County has received free medical treatment
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established. Taiwan's NHI program is the first universal, single-payer health care
insurance program in the world. Under the NHI program, the convenience, accessibility
and affordability of high quality healthcare have greatly improved.
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