Sustainable Immunization Financing in Asia Pacific: Taiwan Country Brief

Key messages

Context

• Taiwan has one of the most robust and comprehensive national health insurance models in the region.
• Taiwan is undergoing a demographic transition, with fertility rates below replacement level and a ‘super’ aging population, sets expectations for stable routine childhood vaccination and provides growth opportunities for lifespan and new vaccines.
• Vaccine-preventable disease morbidity and mortality remains low, owing to national immunization coverage exceeding 95% and comprehensive immunization surveillance (e.g. at hospitals, health centers and schools).

Immunization Financing

• All Taiwanese are entitled to publicly funded routine immunization services in both private and public health facilities, free of charge.
• Taiwan has one of the few dedicated public funding streams for immunization through the National Vaccine Fund (NVF).
• The NVF has been running at a deficit since 2013, and increasingly depleting the Fund reserves each year. External advocacy organizations have suggested that the immunization program be assumed back into the MOHW budget as a line item in hopes that the allocation and spending will be less variable year-to-year.

Key Findings

• Taiwan remains politically centralized, although local government units have fiscal and administrative autonomy of the health program and can influence services to fit local priorities.
• Taiwan has one of the most comprehensive national health insurance programs, but the NHI law stipulates that the program cannot include immunization services. Discussion of incorporation into the benefits package are nascent.
• The Advisory Committee on Immunization Practices is the key player in generating a list of vaccines to be prioritized by the CDC using evidence and scientific support. The CDC uses a comprehensive set of criteria including budget forecasting, CEA and epidemiological studies from the affected regions of Taiwan.
• Taiwan has successfully implemented a tobacco and alcohol tax that is earmarked for health, and specifically for immunization. Approximately, 35% of the total NVF budget is supplied by the tobacco surcharge.
• The NVF can accept private funding and non-monetary philanthropic contributions. In 2014, the NVF accepted a donation to provide the pneumococcal vaccine for the elderly from the Formosa Foundation.