What It’s Like Living In Taiwan Without Health Insurance

I haven’t had health insurance since 2008, which is a pretty crazy thing to say, given that I live in a country with some of the most affordable and high-quality medical care in the world.  National Taiwan Health Insurance, while expensive for the Republic of China (ROC) government of Taiwan, is incredibly cheap for Taiwanese citizens and residents.  Unfortunately for me, I am not a resident of Taiwan, so I don’t have Taiwan National Health Insurance.

Even being totally uninsured, I still make out pretty well, medically-speaking.  If I got a fever and needed a clinic to give me antibiotics, assuming I can walk the two blocks to a local clinic, I will be in-and-out in under an hour and spend less than US$20, which includes the visit (having no appointment and having never been there before) and the drugs to treat whatever’s wrong.  Clinics stock their own on-site pharmacy, saving a lot of time and money.

 

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Understand, I’m not saying it’s perfect.

The National Taiwan Health Insurance system constantly bleeds money because of frivolous use by citizens that pay pennies on the dollar for their care – tax dollars pay for the rest.  For example, that twenty-dollar visit only costs someone with National Taiwan Health Insurance five bucks, so the ROC is paying the remaining fifteen.

The ROC also controls the supply of drugs (i.e. which drugs Taiwan has and doesn’t have); to keep costs down, there are drugs prescribed in Taiwan that are so outdated that you would never see a doctor in the USA prescribing them to anything but livestock.  But, again, for residents, it’s a great thing, and even if you’re an uninsured visitor, it’s easy, affordable, and hassle-free (unlike some other places).

 

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Generally, I do what I can to have my own private stock of drugs I need, to prevent doctor visits.  I have chronic sinusitis, so I get sinus infections; I always keep a supply of azithromycin on-hand (which I usually buy super cheap in the Philippines).

Ever since I was a kid, I’ve always gotten lots of headaches.  Anywhere from one to five times a week, I’ll have some level of headache, and five to ten times a year, they’re full-blown migraines.  All of my acetaminophen and ibuprofen comes from the USA, because the stuff I’ve found here sucks (unless it’s expensive name-brand stuff).  I also keep triptans, which are abortive medications that knock out migraines.  But a few weeks ago, I ran out.

It sucks to run out of something you medically need, especially for something as random and painful as migraines.  It’s like waiting for a bomb to drop while knowing something simple can easily stop it from happening.  As the ROC is responsible for deciding what drugs are available for Taiwan National Health Insurance, there is only one triptan on the island: GlaxoSmithKline’s Imitran (sumatriptan).  And the only places that stock it are hospitals, so you just need to accept your fate.

 

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Unlike the USA, you don’t need to see a general practitioner to see a specialist.  I simply searched for the best-rated neurologist online and then signed up for a place in line online through the hospital website.  There are generally no appointments here, simply a “take a number” system that…somehow…works pretty well.  Check-in in the hospital lobby took less than ten minutes; while I have no government ID card, I do have proof of my government ID number, and since I was in the system in 2008, it made the check-in very easy.  Fifteen American dollars – less than insured co-pay in the USA – got me in.

I waited with other patients outside the neurologist’s office for around twenty minutes before being called in by the nurse.  The doctor and I talked for around ten minutes, discussing what treatments and medications we wanted to employ.  We agreed that my number of yearly migraines have increased compared to the past and that I have many headaches from muscle tension.  Here’s the drugs I got:

 

sumatriptan (GSK Imigran) – 50mg x10

flunarizine (generic) – 5mg x14

cyclobenzaprine (generic) – 5mg x30

 

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That’s enough drugs to last until some point in 2015.  If I had Taiwan National Health Insurance, they would have been free.  Because I’m uninsured, 10 brand-name migraine abortives, 14 generic calcium channel blockers, and 30 muscle relaxers cost me US$85.

Now, when I tell people here in Taiwan how much it cost, they completely freak out, thinking it’s an insane price to pay (because they pay nothing).  For me, I see it as, “I, completely without any insurance, got to see a neurologist and get all the medication I need, and it only cost me a hundred bucks.”

Even when I was last insured in the USA, in 2007, I would have seen costs close to US$100 between a US$20 co-pay to a general practitioner to waste two hours of time so I can be referred to a neurologist, then another US$20+ to the neurologist to prescribe me the drugs I need, then US$20+ for the actual drugs.  And that’s assuming I could get a neurologist to prescribe me muscle relaxers; my mother, who’s in her 50s and has had muscle-based headaches for decades, can’t even get a doctor to script her muscle relaxers (pharmaceutical abuse, unlike in the USA, isn’t really “a thing” here in Taiwan).

So I spent US$100 and an hour of my time to get 10 brand-name migraine abortive, 14 generic calcium channel blockers, and 30 muscle relaxers commonly called “Flexeril,” without any fighting with a doctor or insurance company to get it.  Top that, ObamaCare!

 

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When I fly, I take clonazepam.  I fly multiple times a year, and have, since I was two years old, so it’s not a fear of flying that makes me need the tranquilizers.  It’s just that I enjoy a 14-hour ride in coach one very specific way: unconscious.  To accomplish this, every year or two I find a local psychiatrist, pay less than a cover charge to wait ten minutes and then talk in his office for five minutes, after which time the nurse hands me twenty 2mg clonazepam for US$10.  If I had National Taiwan Health Insurance, it would only cost me five bucks; instead, I – completely uninsured – get 2mg tranquilizers for a dollar a pill.

Traditional Chinese Medical treatment is generally not covered by National Taiwan Health Insurance, but even then, you’re only looking at US$10 per visit and US$10 for a week of traditional “medicine” powders.  Many Taiwanese go that route, because it’s not substantially more expensive to use TCM instead of using actual medicine proven by science to work.

 

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If you want to read about my experiences with TCM, you should click this.

So having National Taiwan Health Insurance is awesome.  It means that, for almost anything you ever need, you’ll spend between US$5-$15 to have it.  And if you are tragically unlucky enough to be uninsured, you’ll still only pay US$10-US$100 to get the exact same thing.  Either way you go – insured or not – Taiwan is an excellent place to stay treated and medicated, especially compared to where I come from.

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