An article published recently in the London Journal of Primary Care examined recent changes in the health system in Taiwan. Taiwan adopted a national health insurance system in 1995. Hence, both the British and the Taiwanese health systems are single-payment systems that offer universal coverage. However, the method of funding is different as the UK system is tax based, and the Taiwan system us other insurance-premium based. Now in its second decade, the National Health Insurance scheme in Taiwan continues to achieve high satisfaction rates among the Taiwanese people. Based on public opinion polls held by the Bureau of NHI, the overall satisfaction rate has consistently been over 70%.11 The next major challenge for the Taiwanese government is to improve quality of care while keeping national healthcare expenditure under control, and dealing with the rising number of older people in the Taiwanese population.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

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