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2O11 ly WoiId Scienlihc IulIishing Co. DOI: 1O.1142/SO218927511OO1496
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Tnis casc uas prcparcd oq
Prcf. ]ui-fcn Racnc| |u cf
Cnang Gung Unitcrsi|q,
Prcf. Tcrcncc Tsai and
Rcscarcn Assccia|c Snuoc
Pni|ip |iu cf Cnina |urcpc
|n|crna|icna| 8usincss Scncc|
as a oasis fcr c|ass discussicn
ra|ncr |nan |c i||us|ra|c ci|ncr
cffcc|itc cr incffcc|itc nan-
d|ing cf an adninis|ra|itc cr
ousincss si|ua|icn.
A|| cf |nc jgurcs in |nis casc
arc disguiscd. Tnc rcscarcn
ucr| assccia|cd ui|n |nis casc
uas suppcr|cd oq rcscarcn
gran|s frcn |nc Cnina |urcpc
|n|crna|icna| 8usincss Scncc|
and Na|icna| Scicncc Ccunci|
(NSC96-2416-H-182-001-
MY3) in Taiuan. lc a|sc
ac|ncu|cdgc |nc suppcr| cf
Cnina |urcpc |n|crna|icna|
8usincss Scncc| Casc Dctc|-
cpncn| Ccn|cr.
P|casc scnd a|| ccrrcspcn-
dcncc |c Prcf. Tcrcncc Tsai,
Cnina |urcpc |n|crna|icna|
8usincss Scncc| Casc Dctc|cp-
ncn| Ccn|cr and Dcpar|ncn|
cf Managcncn|, Cnina |urcpc
|n|crna|icna| 8usincss Scncc|,
699 Hcngfcng Rcad, Pudcng,
Snangnai, P.R. Cnina. |-nai|.
||crcnccccios.cdu
%&'()'*+ - ./01'2-( !(('-*34 5
6-'7-* 8-*)044) 94)'3-( !(('-*34
|n a pcpu|ar sccnc frcn |nc c|assic Cnincsc nis|crica| nctc|
Rcnancc cf |nc Tnrcc Kingdcns, |nc lci Kingdcn |rics |c
gcoo|c up i|s uca|cr ncignocrs, |nc Snu and lu Kingdcns. Nci|ncr
cf |nc |a||cr |uc rca|ns is ao|c |c dc|cr |nc lci a||ac|s cn i|s cun.
|acing intasicn, |ncq agrcc |c occcnc a||ics and suppcr| cacn c|ncr
as a dcfcnsitc s|ra|cgq. Tncq gc cn |c dcfca| |nc lcis fcarfu| arnq
ui|n |ncir a||icd fcrccs. |n ccn|cnpcrarq Taiuan, fc||cuing |nc
s|ra|cgq cf |nc Snu and lu cnpcrcrs, a grcup cf sna|| ncspi|a|s
nas fcrncd an a||iancc and prcspcrcd in a cu|-|nrca| cntircnncn|.
Di. Vicloi Chang vas one of lhe foundeis and is cuiienlIy
Chief Lxeculive Ofhcei (CLO) of lhe Taivan Landseed
MedicaI AIIiance 58-9!). efoie eslalIishing 8-9!, he
vas an expeiienced inleinisl vho had voiked al Chang
Cung MenoiiaI HospilaI (CCMH) and lhe NalionaI Taivan
Univeisily HospilaI as a cIinicaI feIIov and lhen as an
allending physician. Il vas a lypicaI day foi Di. Chang al
Landseed HospilaI, vilh a fuII scheduIe. He vas ieading lhe
hnanciaI slalenenls of 8-9! hospilaIs foi lhe pasl fev yeais
and nuIIing lhings ovei. Ieifoinance appeaied lo le Iagging,
especiaIIy in lhe iales of ieluin (see Lxhilil 1). Di. Chang
and his coIIeagues had lo hnd an appioach lo enhance lheii
ieluin on lheii caiefuIIy deveIoped inveslnenl.
S0218927511001496.indd 123 7/21/2011 4:30:22 PM
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!"# %&'(

!"#$%&'(#!%" #% #*!+*" ,*"&-..&
/.&!(*, *,,!*"(.
)*+ ),-.,/ 0,/12++1 3+1-4,5 %55-,/4+ 6)03%7 -/4581+2
+-9*: ;<2:5= 1-2:>-4: *<2?-:,52@ A2:,B5-2*+1 -/ !CCDE -: -/-:-,55=
4<;?>-2+1 2+F+>,5 ?>-F,:+ *<2?-:,52 62++ AG*-B-: "7@ H+2?-:+
),-.,/I2 4</:-/8<825= 4*,/9-/9 *+,5:*4,>+ ?<5-4-+2 ,/1 :*+
4<;?+:-:-F+ *+,5:*4,>+ ;,>J+:E :*+2+ 2;,55K :< ;+1-8;K24,5+
?>-F,:+ *<2?-:,52 *,1 9>,18,55= +G?,/1+1 :*+-> /+:.<>J2 ,/1
L<>;+1 , 2:,B5+ ,55-,/4+@
)*+ hisl +-9*: *<2?-:,52 -/ :*+ +,>5= 2:,9+ <L )03%
*,1 28>F-F+1 ,/1 2844++1+1 in a heiceIy conpelilive hospilaI
;,>J+: B+4,82+ <L :*+ ,55-,/4+@ )*+ )03% 9><8?E .-:* :*+
4<;;</ 9<,5 <L MJ++?-/9 ?,4+ .-:* ;+1-4,5 ,1F,/4+;+/:
,/1 5+,1-/9 ;,/,9+;+/: :>+/12EN .,2 -/4<>?<>,:+1 -/ !CC!
:< 8?9>,1+ *<2?-:,5 ;,/,9+;+/: ,/1 2+>F-4+ O8,5-:=E -;?><F+
:*+ ;+1-4,5 +/F-></;+/:E ,/1 ?><;<:+ 9<<1 *<2?-:,5 ?>,4:-4+@
P: *,1 1+;</2:>,:+1 9<<1 ?+>L<>;,/4+ ,/1 ,228;+1 ,
5+,1-/9 ><5+ -/ *<2?-:,5 ;,/,9+;+/: 1+F+5<?;+/: -/ 2;,55
,/1 ;-1K2-Q+1 *<2?-:,52E .*-4* ,44<8/: L<> :*+ ;,R<>-:= <L
*<2?-:,52 -/ ),-.,/@
0$.1*(. #% #,/* ! !" #2. .*$,3 4567-
),-.,/ .,2 , /+.5= -/182:>-,5-Q+1 4<8/:>= ,/1 2++/ ,2 </+
<L :*+ L<8> %2-,/ )-9+>2
,
@ %2 , >+285: <L :*+ B<<;-/9 +4</<;=
-/ :*+ !CST2 ,/1 !CCT2 62++ AG*-B-: D7E ;<>+ >+2<8>4+2 .+>+
?8;?+1 -/:< :*+ *+,5:*4,>+ 2+4:<> :< 2,:-2L= :*+ -/4>+,2-/9
1+;,/1 L<> ;+1-4,5 4,>+@ )*+ 9<F+>/;+/: ,52< +/4<8>,9+1
?>-F,:+ -/F+2:;+/:@ )*-2 ,::>,4:+1 /+. +/:>,/:2 :< B8-51
*<2?-:,52 .*-5+ -/48;B+/:2 2+-Q+1 :*+ <??<>:8/-:= :< +G?,/1
,/1 8?9>,1+ :*+-> L,4-5-:-+2@ )*+ :.< )03% L<8/1-/9 ;+;B+>

,
P/ :*+ :.+/:-+:* 4+/:8>=E ;,/= 4<8/:>-+2 -/ A,2: ,/1 U<8:*+,2: %2-,E -/4581-/9
U<8:* V<>+,E ),-.,/E U-/9,?<>+E (,?,/E :*+ W*-5-??-/+2E ,/1 )*,-5,/1E .+>+ 4,55+1
/+.5= -/182:>-,5-Q+1 4<8/:>-+2@ %2-,/ )-9+>2 >+L+>>+1 :< :*+ *-9*5= !"#"$%&"! "(%)%*+",
<L -%). /%).E 0+).1&%2"E 0%345 /%2"1E ,/1 61+71). These iegions veie lhe hisl )"7$8
+)!3,42+1$+9"! (%3)42+", /<:+1 L<> ;,-/:,-/-/9 +G4+?:-</,55= *-9* .2%745 >,:+2 ,/1
>,?-1 +)!3,42+1$+914+%) B+:.++/ :*+ +,>5= !CXT2 ,/1 !CCT2@ Y= -;?<>:-/9 :+4*/<5<9=
,/1 1+?5<=-/9 ,>;-+2 <L 5<.K?,-1 B8: <L:+/ .+55K+184,:+1 .<>J+>2E :*+= .+>+ ,B5+ :<
8/1+>48: 4<;?+:-:<>2I ?>-4+2 -/ ;,>J+:2 ,55 <F+> :*+ .<>51@
S0218927511001496.indd 124 7/20/2011 3:37:18 PM
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UILDINC A HOSIITAL ALLIANCL 125

hospilaIs, A HospilaI and HospilaI, veie eslalIished duiing
lhis loon, and veie invesled in and nanaged ly physicians
vilh IillIe expeiience in hospilaI nanagenenl.
TLMA nenleis ieninisced aloul lhe slail of lhe
aIIiance in a gioup inleiviev:
Many peopIe nighl vondei vhy ve svilched fion
acadenia lo nanagenenl il has sonelhing lo do
vilh lhe eia, an eia fuII of oppoilunilies, and an eia foi
advenluieis
Di. Chang said:
Di. Huang, one of ny fiiends, cane lo ne and asked if
I vas viIIing lo heIp hin lo lake ovei A HospilaI as an
invesloi. Il vas in 1987. Wilhoul hesilalion, I accepled his
invilalion.
Il vas haid lo decIine lhe invilalion fion a fiiend, in
addilion, il vas an oppoilunily lo nanage a hospilaI of oui
ovn.
Il vas difhcuIl in lhe leginning, vilh piolIens aiising
innedialeIy foi lhe TLMA adninislialion. Ioi exanpIe, lhe
day aflei A HospilaI vas laken ovei ly Di. Huang, he had
lo luin lo Di. Chang foi peisonneI suppoil. Moie lhan haIf
of lhe hospilaIs enpIoyees had decided lo iesign lecause lhe
lakeovei neanl a nev nanagenenl lean, and lhey disIiked
lhe nev iuIes and veie dissalished vilh lhe nev saIaiy
syslen. HaIf of lhe nuises in lhe DiaIysis Cenlei Iefl. LuckiIy,
Di. Chang vas alIe lo hnd nev slaff and saved lhe day.
}usl Iike Di. Chang, nosl of lhe physicians did nol
have any piofessionaI expeiience in hospilaI nanagenenl.
AppaienlIy, hovevei, jusl leing a physician did nol salisfy
lhe anlilions of Di. Chang and his coIIaloialois, and lhey
veie pinning a Iol of hope on lheii caieei liansilion in lhe
piospeious heaIlhcaie indusliy.
Tvo yeais aflei Di. Chang had enlaiked on his nev
caieei in hospilaI nanagenenl, he vas voled supeiinlendenl
of HospilaI, aflei he and his fiiends look il ovei. He quil
his posilion as a physician al CCMH and connilled hinseIf
lo a nev slail.
AIlhough nosl nevIy eslalIished hospilaIs did veII
hnanciaIIy in lheii eaiIy peiiod, lhey couId nol oveilake lheii
S0218927511001496.indd 125 7/20/2011 1:45:46 PM
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126 ACR}

conpelilois in lhe naikel. Iiivale disliicl hospilaIs Iacked
econonies of scaIe, and lhus lheii deveIopnenl vas Iiniled.
The TLMA nenlei hospilaIs oiiginaIIy leaned up vilh one
sinpIe goaI: lo nake joinl puichases lo achieve econonies
of scaIe. The aIIiance vas eslalIished lhanks lo Di. Changs
gieal effoils and Iiaison skiIIs. y voiking in hospilaIs foi
nany yeais, he had deveIoped an exlensive nelvoik of peei
physicians fion diffeienl hospilaIs. He ieached oul lo his
peeis and foinei coIIeagues and peisuaded lhen lo join lhe
aIIiance. efoie Di. Chang joined HospilaI, seveiaI of his
fiiends had inviled hin lo le lhe supeiinlendenl of lheii
hospilaIs. Di. Chang said:
I lhoughl aloul lheii invilalions and lhe idea of an aIIiance
cane inlo ny nind. I legan lo Iook aiound lo hnd olhei
snaIIei hospilaIs lhal veie lhe nosl IogicaI pailneis lo join
us. We had leen coIIeagues and fiiends foi quile a vhiIe
and knovn each olhei veII. Il vouId nol le difhcuIl foi us
lo coopeiale fuilhei.
" #$% $#&'()#*$#+ ! '# +,$ -../0
Taivans NalionaI HeaIlh Insuiance (NHI) syslen (see
Lxhilil 4) vas inpIenenled in 1995, neiging lhiee najoi
sociaI insuiance piogians" naneIy Coveinnenl LnpIoyee
Insuiance, Laloi Insuiance, and Iainei Insuiance (see
Lxhilil 5), and expanding insuiance coveiage lo incIude lhe
uninsuied" vho accounled foi neaiIy 43 of lhe popuIalion#
Taivans NHI piogian offeied eveiy cilizen neaiIy equaI
access lo conpiehensive heaIlh seivices and piovided aII
cilizens vilh hnanciaI iisk pioleclion fion Iaige nedicaI
expenses. Al lhe sane line, il aIIoved palienls lo fieeIy
choose lheii piovideis, and hospilaIs and physicians lo
fieeIy choose lheii piaclice node and le paid nainIy on
a fee-foi-seivice lasis. The piogian enjoyed an unusuaI$%
high salisfaclion iale (7O) since ils inceplion, and ieceived
voiIdvide iecognilion. IauI Kiugnan, lhe veII-knovn eco-
nonics piofessoi fion Iiincelon Univeisily and 2OO8 &'()$
MenoiiaI Iiize Iauieale in Lcononics, piaised lhe len-yeai
expeiience of lhe piogian: The oiiginaI pulIic insuiance
S0218927511001496.indd 126 7/20/2011 1:45:46 PM
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UILDINC A HOSIITAL ALLIANCL 127

schenes incIuding goveinnenl enpIoyees insuiance, Ialoieis
insuiance, and faineis insuiance onIy coveied aloul 59 of
lhe lolaI popuIalion. Hovevei, lhe inpIenenlalion of NHI
has iesuIled in univeisaI coveiage, vhiIe in econonic leins,
ieaI nedicaI cosls had onIy iisen sIighlIy
(
.
The inlioduclion of lhe NHI schene opened up noie
oppoilunilies foi hospilaIs, vhich couId offei a luffel of
seivices lecause of lhe fasl-gioving denand and fee-foi-
seivice paynenl nelhod. Many physicians slailed lo invesl
in lhe heaIlhcaie indusliy. In lhe eaiIy days of lhe schene,
neaiIy aII hospilaIs veie alIe lo geneiale suipIuses. The
fuluie Iooked good. Di. Huang, lhe supei*+,)+-)+, of A
HospilaI said:
As one of lhose vho joined lhe liend, ve did nol even
do hnanciaI evaIualion lecause ve leIieved ve vouId ()
alIe lo conlinue lo geneial) suipIuses in lhe fuluie.
We did an appioxinale foiecasl of expendiluie lefoie
ve decided vhelhei oi nol lo lake ovei a hospilaI. We did
so onIy if lhe hospilaI vas piedicled lo lieak even vilhin
hve yeais. SiniIaiIy, ve sel up a nev hospilaI onIy if il
vas piedicled lo le alIe lo geneiale a suipIus in eighl lo
len yeais.
AcluaIIy, ve did nol have nuch expeiience in nanage-
nenl al lhal line, and ve even nade nislakes in oui
caIcuIalion of piohl. We suivived lhanks lo lhe looning
naikel in lhal peiiod. AInosl aII pIayeis veie geneialing
suipIuses in lhe fiee-foi-aII heaIlhcaie naikel.
Hovevei, lhe inpioved access lo heaIlhcaie quickIy
inlensihed naikel conpelilion. In addilion, nol Iong aflei lhe
inpIenenlalion of lhe NHI schene, heaIlhcaie cosls slailed lo
oulpace pieniun incone in 1998 and lhe goveinnenl faced
nounling piessuie due lo econonic change and hnanciaI
condilions (see Lxhilil 6). The schene cunuIaliveIy incuiied
Iaige dehcils
.
#
(
hllp://vvv. Nhi,gov.lv/LngIish/veldala.asp`nenu=11&nenu_id=29O&veldale_
id=19O68&IsIiinl=1
.
T. M. Cheng, 2OO3. Taivans nev NalionaI HeaIlh Insuiance piogian: Cenesis and
expeiiences so fai. !"#$%& ())#*+, 22(3): 61!76.
S0218927511001496.indd 127 7/20/2011 1:45:46 PM
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128 ACR}

$#&'()#*$#+"1 2,"#3$ ! "4+$( -..5
A gieal nunlei of physicians fion pulIic hospilaIs sav
lhe huge polenliaI of lhe heaIlhcaie naikel in Taivan and
pIunged inlo lhe lusiness aiena, lul fev of lhen consideied
aIIiances.
Iion lhe Iale 198Os, lhe nunlei of piivale hospilaIs
sleadiIy decIined, lul lhe speed of lhal decIine acceIeialed
aflei lhe inlioduclion of NalionaI HeaIlh Insuiance (NHI)
piogian in 1995 (Lxhilil 7). The inpIenenlalion of NHI,
vhich signihcanlIy ieduced lhe nonelaiy cosl loine ly lhe
insuied, inlensihed conpelilion in lhe hospilaI naikel. IeopIe
vho opled foi slale-of-lhe-ail nedicaI lechnoIogy ciovded
inlo leiliaiy nedicaI inslilulions, even foi ninoi iIInesses.
Olheis piefeiied geneiaI piaclilioneis in neighloihood cIinics
foi lhe sake of convenience and easy access. Hence, lhe
denand foi caie piovided al lhe lvo exlienes of lhe spec-
liun (nedicaI cenleis veisus cIinics) consislenlIy incieased.
Al lhe sane line, lhe pulIic lianspoilalion syslen nade
liaveIing lo nedicaI cenleis in lhe cily easiei, and lhe
denand foi seivices al snaII IocaI hospilaIs vilhoul liand
iecognilion legan lo shiink iapidIy (see Lxhilil 7).
A fuilhei enviionnenlaI change occuiied vhen lhe
uieau of NalionaI HeaIlh Insuiance (NHI) decided lo
focus on cosl conlainnenl and inpIenenled vaiious iefoins.
Since lhe inpIenenlalion of NHI, appioxinaleIy 92
-
of
hospilaIs had leen conliacled undei lhe &/0 piogian. The
insuied couId choose vhich hospilaI lo allend, vhich Ied
lo conpelilion anong hospilaIs. Wilh lhe iefoin, a CIolaI
udgel (C) syslen inposed an oveiaII spending cap lhal
vas piospecliveIy sel and agieed upon lhiough negolialions
lelveen consunei, piovidei" and insuiei iepiesenlalives
in lhe pievious yeai. If lhe seivice voIune giev faslei lhan
expecled, lhen lhe unil piice f)$$ accoidingIy. IoIIoving
inpIenenlalion of lhe syslen, hospilaI cosl IeveIs ienained
high lul ieinluisenenl iales diopped, vhich nade lhe
silualion of piivale hospilaIs difhcuIl. A gieal nunlei of

-
Slalislics of CeneiaI HeaIlh, 1991 and 2OO7. Depailnenl of HeaIlh,
Lxeculive Yuan, R.O.C. (Taivan).
S0218927511001496.indd 128 7/20/2011 1:45:46 PM
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UILDINC A HOSIITAL ALLIANCL 129

snaII piivale hospilaIs cIosed dovn lecause of decIining
seivice voIunes and unlaIanced checklooks (see Lxhilil 7)#
Di. Huang, one of lhe TLMA diieclois, said:
The NalionaI HeaIlh Insuiance syslen vas in ux.
HospilaI ieinluisenenls veie no Iong)1 as geneious, and
lhe NHI slailed lo acliveIy conlain heaIlh expendiluies.
Wilh lhe Iaunching of lhe CIolaI udgel syslen" 'ui nev$%
eslalIished hospilaI, Iike olhei snaIIei hospilaIs in Taivan,
faced signihcanlIy loughei .'+,1'$s.
Di. Huang said:
Aflei lhe iefoin of lhe NHI syslen, lhe peicenlage of
Landseeds piohl fion piivale heaIlhcaie seivice iose
fion 1O lo 2O, hovevei, lheie vas laieIy any piohl
fion NHI-paid seivices on sone occasions, and lhe noney
eained fion seIf-pay seivices needed lo nake up foi lhe
insufhcienl funding of NHI-coveied seivices.
Wilh Iiniled iesouices and high expeclalions of heaIlhcaie
quaIily fion lhe insuied, vhal neasuies couId piivale
hospilaIs lake lo neel lhis chaIIenge`
+,$ "11'"#2$ '# " 2,"#3'#3 $#&'()#*$#+ !
4()* +,$ -.6/0 +) 7-0+ 2$#+8(9
2345 heIped nenlei hospilaIs navigale lhe upheavaI
iesuIling fion lhese poIicy changes. Coopeialion in joinl
puichasing lecane a decisive advanlage as conpelilion
lecane inlense and goveinnenl suppoil decIined.
Di. Huang connenled:
IoilunaleIy, lefoie NHI vas in pIace, ve had aIieady
foined lhe aIIiance, lul ve had done il nainIy foi joinl
puichasing and cosl culling. Al lhal line, lhe olhei nen-
leis of lhe aIIiance veie nol lhal anlilious lo eslalIish a
hospilaI consoiliun and coIIaloiale in olhei vays. Whal
lhey vanled vas lo keep dovn lhe cosls incuiied ly oui
aIIiance.
To alliacl palienls, ve had lo achieve a high cuie
iale, and lhe high iale vas lased on lhe nedicines ve
puichased and used. Thanks lo lhe aIIiance, ve couId
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678 59:;

laigain foi and puichase high-end nedicines olhei disliicl
hospilaIs couId nol affoid.
One TLMA nenlei added:
Ioi naikeling puiposes, lhe aIIiance heIped nenlei
hospilaIs eslalIish a liand nane as a caie inslilulion vilh
a sliong iepulalion. AIso, oui hospilaI aIIiance enjoyed
econonies of scaIe in luIk puichasing (especiaIIy foi diugs
and sundiies) and on-jol liaining piogians.
This IeveI of coopeialion, hovevei, vas sliII nol sufhcienl
in lhe changing naikel enviionnenl. When Di. Chang
lecane supeiinlendenl of HospilaI, he devoled hinseIf ,'
ieinfoicing and luiIding on conneclions vilh olhei 2345
nenlei hospilaIs. He peisuaded lhose invoIved lhal ly
eslalIishing a Iaigei hospilaI syslen and nainlaining a
naikel shaie foi lhe syslen as a vhoIe, a liggei poilion of
lhe naikel couId le capluied and TLMA nenleis vouId
have giealei laigaining povei vilh lhe <&/0, lhus alliacling
noie palienls#
+:; 3<=>?: =@ +1*"
ShoilIy aflei lhe inlioduclion of lhe C syslen, in iesponse
lo lhe incieased conpelilion, Di. Chang, aIong vilh his
associales, legan lo lhink aloul fuilhei coIIaloialion:
The enviionnenl vas aIvays changing and oui posilion
vas nevei secuie. In lhe heiceIy conpelilive Taivanese
heaIlhcaie naikel, ve needed lo aIIy vilh noie hospilaIs
lo le a counleilaIancing foice againsl veII-eslalIished and
anlilious hospilaIs.
In ny opinion, hospilaI neigeis haidIy evei pioduce
lhe expecled lenehls. Hence, I inlended lo deveIop a
hospilaI aIIiance lhiough vhich ve couId have noie
effeclive and exilIe coIIaloialion. The aIIiance vouId
aIso eslalIish a good iepulalion and nainlain good
ieIalionships vilh goveinnenl and olhei hospilaIs.
ReaIizing lhe inpoilance of coopeialion and lased on ils
eaiIy coIIaloialion expeiience, 2345 inviled noie hospilaIs
lo join il and legan lo coIIaloiale in noie aieas, incIuding
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UILDINC A HOSIITAL ALLIANCL 131

HR nanagenenl, and acadenic, cIinic, faciIily, and iesouice
shaiing.
The 2345 hospilaIs veie Iocaled in diffeienl aieas
of Taivan, vilhoul oveiIapping naikels and nol in diiecl
conpelilion vilh each olhei. In addilion, lhe aIIiance pio-
vided nenlei hospilaIs vilh conpIenenlaiy iesouices. They
couId lack up each olhei vilh lheii speciaIlies and ollain
iesouices lhal no singIe nenlei hospilaI couId have. As
snaII connunily hospilaIs, lhey veie nol alIe lo conpele
vilh iegionaI hospilaIs in leins of faciIilies and vaiious
seivices. Ioi exanpIe, a singIe connunily hospilaI couId nol
affoid a CT 128 nachine foi in-deplh heaIlh check seivices,
lul lhiough 2345" nenleis couId puichase lhe equipnenl
and shaie lhe cosl. The aIIiance aIso enalIed nenlei
hospilaIs lo eslalIish a iepulalion foi offeiing good heaIlh-
caie seivices. In addilion, lhe nedicaI vasle fion aIIiance
hospilaIs vas coIIecled and disposed of in lalch liealnenl.
y 1995, 2345 incIuded eighl hospilaIs as Iong-lein
nenleis, lhiee of vhich veie ovned ly lheii nanagenenl.
Di. Chang vas eIecled CLO of 2345, and oulside of lhe
aIIiance he look nuIlipIe posilions in nedicaI and govein-
nenlaI oiganizalions. Ioi exanpIe, he has leen a .onnillee
nenlei of lhe HospilaI Acciedilalion piogian, Iiesidenl
of lhe Associalion of Chinese HeaIlhcaie Managenenl and
Taivan RegionaI HospilaI Associalion, and an audiling
physician al lhe NHI.
To nanage lhe aIIiance veII, he liealed each hospilaI in
a faii nannei:
I liealed aII TLMA nenlei hospilaIs equaIIy. Regaiding
iepoiling lianspaiency, lhe eainings and accounls of aII
aIIiance hospilaIs veie avaiIalIe lo aII of oui nanagenenl
lean nenleis.
Olhei neasuies veie aIso necessaiy lo ensuie lhe conlinued
success of lhe aIIiance.
" 4A<B 9;? 4C;DAEC; "CCAFGH; 0?<IH?I<;
Mosl of lhe hisl TLMA nenlei hospilaIs did nol have
piopeily iighls foi lheii hospilaI luiIdings +oi ofhces lecause
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67= 59:;

of insufhcienl funding. Il vas difhcuIl lo gel ciedil fion
lanks, and lhe nosl ieIialIe and convenienl vay lo iaise
noney vas lhiough peisonaI Ioans laken ly lhe shaiehoIding
doclois. UndeislandalIy, lhen, each hospilaI vanled lo ielain
ovn idenlily.
UnIike in olhei neigei and acquisilion cases, TLMA
nenlei hospilaIs did nol need lo adopl a nev cuIluie oi
nanagenenl slyIe lo voik logelhei. Ralhei, each hospilaI
nainlained ils independence in lolh nanagenenl and
hnance. Hovevei, lhey did have sonelhing in connon: a
coipoiale idenlily syslen (CIS). AII nenlei hospilaIs loie
lhe sane Iogo and sIogan, and slaff nenleis voie lhe sane
unifoins. 2345 hospilaIs aIso co-pulIished a hospilaI nan-
agenenl peiiodicaI, -#./,""/ !0,1*%#$ 2#.#3"4".% 5"6,$"%%"+#
2345 allached gieal inpoilance lo lhe ioIe of ils CIS.
Di. Chang said:
We needed lo have sonelhing in connon, such as a
shaied nane and Iogo. We spenl neaiIy hve yeais luiIding
oui aIIiance. Duiing lhis piocess, sone diagged lheii feel
lecause lhey couId nol accepl ny nanagenenl ideas,
vhiIe conpelilion iesuIled in olheis cIosing dovn. Those
vho vilhslood lhe difhcuIlies veie viIIing lo vaIk fuilhei
vilh ne The Chinese saying One nevei hides ones
nane no nallei vhal shovs lhe piide one lakes in ones
nane and oiigin. I vas viIIing lo Iel hospilaIs change lheii
nanes lo leai a shin lo signaI Landseed nenleiship.
This vas aIso a vay lo denonsliale oui deleininalion lo
le aIIied. SeveiaI polenliaI nenleis vaIked oul lecause
lhey vouId nol change lheii hospilaI nanes.
2345 aIso inpIenenled a nunlei of neasuies lo eslalIish
a unihed idenlily. Theie veie lhiee inpoilanl annuaI evenls
lo loIslei lhe sense of leing pail of a lean: a spoils day,
a cuIluiaI feslivaI, and a yeai-end paily. HospilaI supei-
inlendenls nel eveiy lhiee nonlhs lo iepoil on lheii
hospilaIs lo Di. Chang as CLO. Duiing lhe neelings, lhe
supeiinlendenls gol lo knov each olhei and shaied infoi-
nalion on poIicy changes and naikel liends, and voiked oul
connon slialegic goaIs. An annuaI ielieal vas aIso oiganized
foi hospilaI supeiinlendenls and nanageis, vilh Iecluies and
voikshops in hospilaI nanagenenl heId.
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UILDINC A HOSIITAL ALLIANCL 133

In 1995, 2345 eslalIished Landseed HospilaI as ils
agship hospilaI in a lovn aloul haIf an houis diive fion
Taoyuan InleinalionaI Aiipoil. Di. Chang vas voled ly
his coIIeagues lo le lhe supeiinlendenl of lhe nev hospilaI.
He pIanned lo nake il a iepulalIe iegionaI hospilaI, and
look chaige of aII of lhe consliuclion delaiIs. Di. Changs
coIIeagues connenled:
He joined in lhe aichilecluiaI design and even pIayed lhe
ioIe of piojecl supeivisoi and cane on sile eveiy day,
spending a gieal deaI of line lo oveisee lhe piogiess of
consliuclion.
He is a veiy eneigelic peison, fuII of passion and
inleiesling ideas. Landseed HospilaI vas his idea. He
vouId sonelines conlinue voiking foi noie lhan 2O houis
a day 'n lhe consliuclion sile His voiking slyIe lo sone
exlenl has nade nany of oui pIans cone liue.
He is a voikhoise. Aflei lhese yeais voiking logelhei,
vhal ve have seen is lhal Chang viII aIvays sel his
shouIdei lo lhe vheeI. His high devolion lo voik has
enalIed us aII lo liusl hin and feeI lhal he is ieIialIe.
Lach 2345 nenlei hospilaI conliiluled lo lhe eslalIishnenl
and deveIopnenl of lhis geneiaI hospilaI and lacked il
up vilh advanced nedicaI lechnoIogy and equipnenl (see
Lxhilil 1). Supeiinlendenls and physicians fion 2345
hospilaIs iaised noney ly appIying foi peisonaI Ioans, as
lhey feIl conhdenl in invesling lheii ovn noney in Landseed
HospilaI and had gieal hopes foi ils success undei Di.
Changs Ieadeiship.
Di. Chang consislenlIy enphasized inpioving seivice
quaIily and hospilaI nanagenenl. Landseed HospilaI vas lhe
hisl nedicaI inslilulion in Asia lo lecone iegisleied lo lhe
ISO 9OO2 quaIily nanagenenl and ISO 14OO1 enviionnenlaI
nanagenenl slandaids. AII olhei 2345 nenlei hospilaIs
couId luy inpoiled high-end nedicines al a piice nuch
Iovei lhan naikel '+) lecause lhe liansaclion cosls veie
ieduced lhiough Landseeds coopeialive puichasing piogian.
Landseed HospilaI vas aIso lhe liaining and acadenic cenlei
foi 2345 nenlei hospilaIs, vilh each sending ils nevIy
ieciuiled slaff lo lhe hospilaI lo allend annuaI liaining
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134 ACR}

piogians. Olhei deveIopnenl piogians incIuded niddIe-
and high-IeveI nanagei and on-jol liaining.
In 2OO5, Di. Chang and his aIIies eslalIished lhe
Landseed MedicaI AIIiance Associalion. The supeiinlendenls
fion lhe eighl nenlei hospilaIs lecane loaid nenleis,
laking luins as piesidenl of lhe associalion. Di. Chang vas
appoinled lhe associalions secielaiy-geneiaI. AII 2345
liaining and ieseaich aclivilies veie caiiied oul lhiough lhe
associalion.
TLMA nenlei hospilaIs ollained suppoil fion each
olhei lhiough lhe aIIiance. Mosl, foi inslance, had Iiniled
hunan iesouices in lheii nedicaI unils. When a physician Iefl
oi iesigned fion a hospilaI, one fion anolhei 2345 hospilaI
vas ieIocaled ,' suppoil seivice deIiveiy lenpoiaiiIy. Senioi
slaff in lolh acadenic and nanagenenl posilions veie
lhus iecognized ly aII 2345 nenlei hospilaIs, vhich aIso
piovided caieei exiliIily and secuiily, and kepl lhe luinovei
iale Iov.
Di. Huang connenled al lhe line:
A hospilaI has onIy a nodesl pIace in lhe naikel, lul
ve feeI safe and conhdenl logelhei vilh olhei nenleis
lecause each nenlei has ils ovn speciaIly and slienglh
in one heId. y conlining oui slienglhs and expeilise, ve
have a speclacuIai aIIiance lhal suppoils each nenlei, and
ve aie unlealalIe.
Hovevei, HR aiiangenenls vilhin lhe 2345 gioup veie
sonelines sliained, especiaIIy vhen a hospilaI had lo piovide
peisonneI even lhough il vas ilseIf expeiiencing a slaff
shoilage.
1;FJ;<K:AL FGJ 0:F<;J &FCI; AG ?:; "CCAFGH;
2345 voiked veII lecause of ils effeclive coopeialion
nechanisns and Di. Changs haid voik and conscienlious
nanagenenl. The Chief Diiecloi of lhe IulIic HeaIlh Ofhce
spoke highIy of Di. Chang:
He has good nasleiy of lhe Ialesl poIicies and undeislands
veII lhe changing heaIlhcaie naikel in Taivan.
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UILDINC A HOSIITAL ALLIANCL 135

>+) <&/0 slaff nenlei said of Di. Chang:
He cones lo nany neelings heId ly us and olhei nedicaI
associalions so he undeislands veII Taivans poIilicaI
enviionnenl and lhus is viIIing lo acliveIy voik vilh us
He is good al connunicaling and cooidinaling. When
he vas chaii of lhe HospilaI Co-nanagenenl CounciI, he
vas alIe lo negoliale vilh aII lhe supeiinlendenls of lhe
hospilaIs vilhin Noilhein Division of NHI.
Di. Changs coIIeagues connenled:
Nolody vanls lo conpele vilh Di. Chang foi lhe posilion
of CLO of 2345" lecause lhe vhoIe aIIiance syslen vas
eslalIished ly hin, and he luiIl lhe liidges lhiough vhich
ve legan lo knov each olhei and slailed lo coIIaloiale
We have ollained nosl of oui oulside venluie capilaI
lhiough his peisonaI nelvoiks.
Di. Chang hinseIf connenled:
I have pIedged lo do eveiylhing faiiIy since I look
lhe posilions as CLO of 2345 and supeiinlendenl of
Landseed HospilaI. When I give ny void, I nevei lack
oul. I viII liy ny lesl lo honoi ny pionises. In addilion,
I lieal eveiyone vilh honesly, and I do nol voik foi
peisonaI hnanciaI gain (I nevei lake a peifoinance-lased
lonus). I an happy if ny coIIeagues liusl and suppoil ne
fuIIy in ieluin.
Di. Chang handIed lhe aIIiance vilh gieal caie lecause he
knev lhal aII of lhe supeiinlendenls veie expeils in lheii
ovn heIds and lhal lhe hospilaIs had diffeienl cuIluies.
IIexiliIily and skiII veie iequiied in supeivising lhe hospilaIs.
Di. Chang said:
(.7 0." 0) %&" 8-2( 4"49"+ &0,1*%#$, :0;$/ %;+. *%, 9#:< 0.
%&" #$$*#.:"= 8&"7 :0;$/ :&00," %0 /0 9;,*.",,", 97 %&"4,"$>", "
unq fc||cu nq |cad? lna| is ncrc, as citi| cfjcia|s, |nc
supcrin|cndcn|s natc sccurc pcsi|icns. | natc nc rign| |c jrc
%&"4 ">". *) %&"7 /*,09"7 47 :044#./,= -;:<*$7? 6" 60+<
%03"%&"+ 6"$$ 9":#;," 6" &#>" 60+<"/ %03"%&"+ 9")0+" #./ <.06.
"#:& 0%&"+ )0+ # $0.3 %*4"= @#,"/ 0. %&#%? A ,"% 47 ,*3&%, 0.
9;*$/*.3 ;1 # ,0$*/ #$$*#.:"B A #4 # /"%"+4*."/ 1"+,0.? #./
1"+,;#,*>" ".0;3& %0 3;*/" C#$$*#.:" 4"49"+,D 0. 4#.7 *,,;",=
S0218927511001496.indd 135 7/20/2011 1:45:46 PM
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136 ACR}

Di. Chang vas caulious in choosing his pailneis. Honesly
vas his hisl consideialion, as he lhoughl an aIIiance couId
nol achieve suslainalIe deveIopnenl vilhoul liusl and good
ieIalionships anong ils nenleis. He vas disposed lo ieciuil
peopIe vilh lackgiounds siniIai lo his ovn lecause il vouId
le nuch easiei foi lhen lo liusl one anolhei, and lhis nuluaI
liusl vouId le a ciilicaI facloi in TLMAs success. He said:
In Taivan and nainIand China, diffeienl fion lhe US,
hospilaI nanageis aie supposed lo have a nedicaI
lackgiound. OnIy doclois can ieaIIy knov vhal palienls
+))-#
Anong physicians, ve have a kind of naluiaI liusl.
Sonelines ve do nol even need a conliacl, as ve can
coIIaloiale lased on oiaI pionises.
Il lakes line lefoie I can deIegale lasks lo olheis, lul
once lheii elhicaIily is pioved and I can see lheii aliIily,
I an alIe lo pIace ny conhdence in lhen and liusl lhen
oveiaII.
Di. Chang lhoughl lhal doclois vouId caie noie aloul
offeiing piofessionaI high-quaIily heaIlhcaie seivices lhan
lusiness peopIe, vho vouId lhink onIy of nonelaiy gain.
One najoi shaiehoIdei did diop oul of lhe aIIiance
lecause his lusiness inleiesls veie nol aIigned vilh lhe
conceins of Di. Chang and his physician coIIeagues. AIIiance
supeiinlendenls found lhal lhe shaiehoIdei ignoied lhe
quaIily of heaIlh caie in ciilicaI aieas, vhich conicled vilh
Landseeds coie vaIue and nanagenenl phiIosophy. The
physicians vouId nol loIeiale lhe Iov)1ing of lheii slandaids
+oi ignoie nedicaI elhics lo naxinize piohls oi shaiehoIdei
vaIue.
)44$('#3 M$++$( ,)0N'+"1 0$(&'2$0
TLMA enphasized heaIlhcaie seivice enhancenenl anong ils
aIIiance hospilaIs. The TLMA nenleis slaled:
In pioviding heaIlhcaie seivice, ve need lo offei con-
passionale and hunane caie lo oui cusloneis. To do lhis,
ve need lo deveIop a cuIluie of sinceiily, goodness, and
leauly.
S0218927511001496.indd 136 7/20/2011 1:45:46 PM
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UILDINC A HOSIITAL ALLIANCL 137

In C HospilaI, leing nice and poIile vas incoipoialed
inlo lhe hospilaI cuIluie. LnpIoyees in fionlIine seivice and
adninislialive posilions veie iequiied lo lake couilesy
Iessons. In Landseed HospilaI, palienls couId ieceive caie
seivices accoiding lo lheii speciaI needs and condilions.
4"2'#3 48+8($ 2,"11$#3$0
2345 sav sleady giovlh in ils iepulalion. Di. Chang
connenled:
Thiough lhe inpiovenenl of nedicaI caie slandaids and
seivice quaIily, a veIconing nedicaI enviionnenl as veII
as high-quaIily, highIy efhcienl, and piofessionaI nedicaI
seivices can le enjoyed ly lhe pulIic.
)
Hovevei, despile lhis success, Di. Chang noliced lhal lhe
iales of ieluin foi 2345 hospilaIs had slagnaled. As lhe
CLO of lhe aIIiance and supeiinlendenl of Landseed HospilaI,
he vas capalIe of handIing an innense anounl of voik each
day. In addilion, he vas a fasl decision nakei " he couId
aIvays nake up his nind vilhin lhiee days and slick lo
his decisions. Di. Chang nov needed lo oiganize a neeling
vilh his coIIeagues lo hguie oul a pIan foi iesliucluiing
Landseed HospilaI lo nake il noie opeialionaIIy efhcienl. He
lhoughl aloul lhe vaiious issues lo le discussed vilh aIIiance
nenleis in foilhconing neelings and lhe need lo hnd
ansveis lo lhese queslions. Civen noie sliingenl NalionaI
HeaIlh Insuiance (&/0? paynenl poIicy, hov couId lhe aIIied
hospilaIs suslain lheii piohl naigins` ShouId lhey Iook foi
a nev venluie in lhe China naikel as lhe Taivanese naikel
vas leconing saluialed`
($4$($#2$0
1. Lu, }. R. and Hsieh, C. R. 2OOO. The NalionaI HeaIlh Insuiance
Iiogian in Taivan. In HeaIlh Lcononics (Chaplei 14). Taipei:
Iio-Ld IulIishing Conpany. Dala aflei 1995.
)
hllp://vvv.Iandseed.con.lv/sile/ush/cl.asp`xIlen=126O&ClNode=399.
S0218927511001496.indd 137 7/20/2011 1:45:46 PM
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.
138 ACR}

2. Lu, }. R. and Hsiao, W. C. 2OO3. Does univeisaI insuiance nake
heaIlh caie unaffoidalIe` Lessons fion Taivan. !"#$%& ())#*+,
22(3): 77!88.
3. Lu, }. R., Sheu, }. T. and Shen" 4# 2# Incenlive and conpelilion
in lhe hospilaI naikel undei gIolaI ludgels. Iapei piesenled al
Iiovidei Iaynenl in lhe Asia-Iacihc Confeience in eijing"
2OO8.
4. Cheng, T. M. 2OO3. Taivans nev NalionaI HeaIlh Insuiance
piogian: Cenesis and expeiiences so fai. !"#$%& ())#*+, 22(3):
61!76.
5. NalionaI HeaIlh Insuiance AnnuaI SlalislicaI Repoils 2OOO and
2OO7
6. Slalislics of CeneiaI HeaIlh, 1991 and 2OO7. Depailnenl of
HeaIlh, Lxeculive Yuan, R.O.C. (Taivan).
7. Slalislics of CeneiaI HeaIlh, 1991 and 2OO7. Depailnenl of
HeaIlh, Lxeculive Yuan, R. O. C. (Taivan).
8. hllp://vin.dglas.gov.lv/dglasO3/ls7/caIendai/caIendai.asp`
SeIOig=1&ShiIieId=ShiIln&KeyWid=
9. hllp: //vvv.Iandseed.con.lv/sile/ush/cl.asp`xIlen=126O&
ClNode=399.
1O. hllp: //vvv.Nhi,gov.lv/LngIish/veldala.asp`nenu=11&
nenu_id=29O&veldale_id=19O68&IsIiinl=1
S0218927511001496.indd 138 7/20/2011 1:45:46 PM
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UILDINC A HOSIITAL ALLIANCL 139

Lxhilil 1
Shaies of 2345 HospilaIs ,' Landseed HospilaI and Lach Olhei HospilaIs Ciovlh

Name of
hospital
Share
1993
Revenue
NTD
10,000/
month
1993
Rate of
return
1995
Revenue
NTD
10,000/
month
1995
Rate
of
return
2002
Revenue
NTD
10,000/
month
2002
Rate
of
return
2005
Revenue
NTD
10,000/
month
2005
Rate of
return
2008
Revenue
NTD
10,000/
month
2008
Rate of
return
A
Hospital
5% 2200 12% 3200 20% 2600 16% 2400 14% 2000 8%
B
Hospital
10% 4600 10% 9200 20% 6400 15% 5600 12% 4600 10%
C
Hospital
5% 700 10% 2000 24% 3300 14% 3760 12% 4000 12%
D
Hospital
5%
(in the
year of
2000)
1800
3300 8% 5700 20% 4600 12%
E
Hospital
5% 720 30% 1300 35% 3120 30% 4600 25% 3600 10%
F
Hospital
5% 2400 15% 3000 15% 3000 18% 3600 15%
G
hospital
1600 12% 2400 20%
Landseed
Hospital
12000 12% 30000 8% 36000 9% 34000 5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
1993 1995 2002 2005 2008
R
a
t
e

o
f

R
e
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r
n
Year
Rate of Return for TLMA
A Hospital
B Hospital
Landseed
C Hospital
D Hospital
E Hospital
F Hospital
G Hospital
S0218927511001496.indd 139 7/20/2011 1:45:46 PM
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14O ACR}


19
Financial Statement of TLMA in 2008
Sales revenue
(figures in
millions NTD)
$40,776

Operating
expenses
Cost of
goods sold:
$15,886
Selling, general,
and
administrative
expenses:
$17,344
Depreciation
and
amortization:
$1,920
Other
expenses:
$276
Total operating
expenses: $34,426
Operating
income
Non-
operating
income:
$260

Earnings before
interest and
taxes (EBIT)
$6,710 Net interest
expense/income:
$290

Earnings before
income taxes
$6,420 Income taxes:
$2,054

Net income $4,366






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UILDINC A HOSIITAL ALLIANCL 141

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UILDINC A HOSIITAL ALLIANCL 143

Lxhilil 3
Taivans CDI Ciovlh
hllp://vin.dglas.gov.lv/dglasO3/ls7/caIendai/caIendai.asp`SeIOig=1&ShiIieId=ShiIln&
KeyWid=
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144 ACR}

Lxhilil 4
Taivans HeaIlhcaie Syslen
A.%+0/;:%*0. %0 %&" 5!A F+03+#4
In 2OO7, Taivan spenl 6.13 of ils CDI on heaIlh, vilh diiecl paynenl ly househoIds accounling
foi ioughIy 37 of nalionaI heaIlh expendiluie (Depailnenl of HeaIlh, 2OO7). Taivan inlioduced
a singIe-payei NalionaI HeaIlh Insuiance (NHI) piogian in 1995 aflei neaiIy a decade of
pIanning, incIuding a lvo-yeai IegisIalive naialhon. The goaI of univeisaI coveiage vas
achieved ly inlegialing lhiee lhen exisling sociaI insuiance schenes, naneIy, Laloi Insuiance,
Coveinnenl LnpIoyee Insuiance, and Iainei Insuiance, vhich coIIecliveIy coveied 57 of lhe
popuIalion, and successfuIIy expanding lhe coveiage lo lhe uninsuied, vhich nainIy conpiised
lhe unenpIoyed, eIdeiIy, and young. The NHI piogian piovides a conpiehensive lenehl
package lhal coveis

pievenlive and nedicaI seivices (inpalienl and oulpalienl), piesciiplion
diugs, denlaI

seivices, Chinese nedicine, and hone nuise visils, hnanced nainIy ly payioII-
lased pieniuns, vilh lhe goveinnenl sulsidizing lhe pooi, veleians, faineis, and Ialoieis.
Taivan has a naikel-oiienled heaIlhcaie deIiveiy syslen, ieecling ils fiee-enleipiise econony,
as evidenced ly lhe pIuiaIislic oiganizalion of heaIlh seivices. HospilaI ovneiship is nixed, vilh
pulIic hospilaIs accounling foi 34 of aII leds (Depailnenl of HeaIlh, 2OO7). Sixly-lhiee peicenl
of aIIopalhic physicians aie saIaiied enpIoyees of hospilaIs, and lhe iesl aie fee-foi-seivice
piivale piaclilioneis. Chinese nedicine piaclilioneis, vho aie Iicensed nedicaI piofessionaIs
aIlhough nol aII have undeigone foinaI educalion, nainIy piaclice in piivaleIy ovned cIinics.
HospilaIs have deveIoped Iaige oulpalienl depailnenls and afhIialed cIinics foi piinaiy caie
lo nainlain inpalienl voIune and conpele vilh piivale piaclilioneis vho opeiale fiee-slanding
cIinics vilh leds.
Despile lhe NHI piogians inpiessive achievenenl in assuiing access lo caie foi and piovide
hnanciaI iisk pioleclion lo Taivans 23 niIIion cilizens, fasl-gioving expendiluies lhal
oulpaced pieniun incone had lecone a luining issue ly 1998. IoIilicaI piessuie neanl lhal
lhe pieniun iale had onIy leen incieased once, fion 4.25 lo 4.55, since lhe inauguialion of
lhe piogian. To cope vilh hnanciaI insoIvency, lhe NHI inlioduced vaiious iefoin poIicies
and sel up sepaiale gIolaI ludgels foi denlaI seivices in 1998, Chinese nedicine in 2OOO, ofhce
visils deIiveied ly cIinics (piinaiy caie) in 2OO1, and nosl conlioveisiaIIy, hospilaI oulpalienl
and inpalienl seivices in 2OO2 (vilh funds pooIed fion ludgels foi hospilaI and piinaiy caie, a
gIolaI ludgel foi ienaI diaIysis vas aIso inslaled).
The NHI ieseives veie depIeled in Ieliuaiy 2OO7, and lhe hnanciaI gap as of Maich 2OO8 vas
NT$29.5 liIIion (US$913 niIIion).
!0,1*%#$ G$09#$ @;/3"% H7,%"4
The hospilaI gIolaI ludgel (C) syslen inlioduced in }uIy 2OO2 piovoked vocifeious opposilion
fion hospilaIs. Despile lhe piessuie inposed ly hospilaI gioups, lhen HeaIlh Minislei Ming-
Liang Lee vas fuIIy deleinined lo inpIenenl lhe piogian. Hovevei, lo aIIeviale lhe expIosive
lension lelveen lhe goveinnenl and lhe hospilaI secloi, Lee iesigned jusl one nonlh aflei lhe
piogian vas pul inlo pIace.
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UILDINC A HOSIITAL ALLIANCL 145

The NHI has adopled an expendiluie cap ialhei lhan expendiluie laigel appioach in
adninisleiing lhe C syslen in Taivan. The foinei is oflen caIIed a haid cap lecause lhe
pie-sel expendiluie cap is lhe naxinun lhal piovideis can gel fion lhe insuiei, vheieas
undei lhe expendiluie laigel appioach (a sofl cap), piovideis gel a discounled fee vhen
lolaI expendiluies exceed lhe laigel. Repiesenlalives of enpIoyeis, consuneis, piovideis, and
goveinnenl agencies and lvo expeils/schoIais appoinled ly lhe HeaIlh Minislei (of vhon one
is appoinled as lhe Chaii) negoliale lhe annuaI giovlh iale foi lhe expendiluie cap vilhin lhe
loundaiy sel ly lhe goveinnenl al NHI MedicaI Lxpendiluie Negolialion Connillee neelings.
Then, lhe expendiluie cap foi lhe cuiienl yeai nuIlipIied ly lhe negolialed giovlh iale lecones
lhe expendiluie cap foi lhe foIIoving yeai. The expendiluie cap is fuilhei divided inlo six
sepaiale ludgel caps foi lhe six NHI iegions aflei adjusling foi denogiaphic iisk faclois (lased
on lhe denogiaphic chaiacleiislics of lhe iegionaI insuied popuIalion
f
) and cioss-loidei nedicaI
expendiluies incuiied ly lhe iegionaI insuied popuIalion.
I")"+".:"s
Lu, }. R. and W.C. Hsiao, @# 9# 2OO3. Does univeisaI *nsuiance nake heaIlh .aie unaffoidalIe`
Lessons fion Taivan. !"#$%& ())#*+, JJ(3): 77!88.
Lu, }. R., Sheu, }. T. and Shen" 4# 2# Incenlive and conpelilion in lhe hospilaI naikel undei
gIolaI ludgels. Iapei piesenled al Iiovidei Iaynenl in lhe Asia-Iacihc Confeience in eijing"
2OO8.
f
The iegionaI insuied popuIalion is lhe nunlei of peisons iegisleied undei a NHI iegionaI ofhce and nay nol le
lhe acluaI iesidenl popuIalion. The enpIoyees of lig hins, vhose headquaileis lend lo le Iocaled in lhe capilaI cily,
Taipei, aII iegislei undei lhe NHI Taipei iegionaI ofhce, iegaidIess of vheie lhey voik and Iive.
S0218927511001496.indd 145 7/20/2011 1:45:47 PM
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146 ACR}

Lxhilil 5
K#%# ,0;+:": Dala foi 195O!1994, }.R. Lu and C.R. Hsieh, 2OOO. The NalionaI HeaIlh Insuiance Iiogian in Taivan.
0+ !"#$%& ":0.04*:, (Chaplei 14). Taipei: Iio-Ld IulIishing Conpany. Dala aflei 1995, NalionaI HeaIlh Insuiance
AnnuaI SlalislicaI Repoil, uieau of NalionaI HeaIlh Insuiance.
Insuiance Coveiage Lxpansion in Taivan, Insuied IeopIe as a Ieicenlage of
IopuIalion 195O!2OO7
coveiage
iale
yeai
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UILDINC A HOSIITAL ALLIANCL 147

Lxhilil 6
IinanciaI Slalus of uieau of NalionaI HeaIlh Insuiance, 1995!2OO6
,
1000
1500
2000
2500
3000
3500
4000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Unit: NT$100 million
year
medical benefits premium revenues
H0;+:": uieau of NalionaI HeaIlh Insuiance AnnuaI SlalislicaI Repoil, 2OOO and 2OO7.
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148 ACR}

0
100
200
300
400
500
600
700
800
900
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
N
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Public
Foundation-owned
Private
Lxhilil 7
No. of HospilaIs ly Ovneiship, 1986!2OO8
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