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Health Care Analysis
Erschienen in: Health Care Analysis 2/2020

29.04.2020 | Original Article

Solidarity with Whom? The Boundary Problem and the Ethical Origins of Solidarity of the Health System in Taiwan

verfasst von: Ming-Jui Yeh, Chia-Ming Chen

Erschienen in: Health Care Analysis | Ausgabe 2/2020

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Abstract

Publicly-funded health systems, including those national health services and social or National Health Insurances, are institutionalized solidarity in health. In Europe, solidarity originated from the legacies of labor movements, the Judeo-Christian traditions, and nationalist sentiments in the re-construction Era after the WWII. In middle-to-high income East Asian countries, such as Japan, Taiwan, Korea, the health systems were built on different grounds and do not have such ethical origins of solidarity. As health systems in Europe and East Asia are both facing sustainability crises due to aging population, stagnant economy, changing boundaries, and advancing medical technologies, how those systems with the European solidaristic ethical traditions can be revived and how those without the European traditions could survive become a matter of theoretical interests and an urgent policy problem to be addressed. Drawing on contemporary theories of solidarity, this essay analyzes the boundary problem and its impact on the sustainability of the health system in Taiwan. It then considers two plausible origins of solidarity in Taiwan. One is the re-emerged civic nationalism, and the other is an ethos of common life. It is argued that after years of implementation, the National Health Insurance in Taiwan might have shaped the social values and people’s habits and formed an ethos of common life. Such ethos could be an ethical origin of solidarity in non-western societies and help the health systems endure the prolonged sustainability crises.
Fußnoten
1
Here, for the simplicity of discussion, we specifically refer to those Chinese who consider themselves as the decedents of the Republic of China (ROC), not the People’s Republic of China (PRC).
 
2
Note that this is a hypothetical scenario constructed by the author, not a quotation from an interview. The sentiment may be similar to the exclusionary or even xenophobic sentiments in European countries as well as the individualist perception of responsibility for health in the United States. Despite the different norms and cultures between these places, what in common through the lens of solidarity is the lack of mutual recognition between “us” and “them” in such scenario. We remain neutral to what scope of recognition is ethically justifiable at this moment of argument. The scope could be as wide as the entire population of human species or as narrow as a blood lineage, depending on the contexts. The scenario is used to illustrate the solidaristic rationale.
 
3
We use the term “enemies” here purposefully. It is actually an issue at the very core of conflicts in Taiwanese society that some groups of population are often considered as the nation’s enemies. Note that the “nation” and its “enemies” could be defined in various ways. To name a few: Taiwanese had defined those with Chinese identity as enemies. Chinese had defined those with Taiwanese identity as enemies. Chinese had defined those with ROC identity as enemies. ROC believers had defined those with Taiwanese identity as enemies. There are more combinations. This phenomena derives from Taiwan’s experiences in being under multiple colonialism [60]. We are not suggesting that these de facto definitions are justifiable, but rather, we are suggesting that even though they are dynamic and subject to change under the international relationship and the attitudes of geopolitical stakeholders, such as Beijing and Washington D.C., they should be taken into account seriously by those who care about the future of the NHI.
 
4
Which is highly probable due to the structural challenges mentioned before. According to an official actuarial estimation, the NHI fund will be in deficit by the end of 2021 if the covered services package and the rate of premium are held unchanged [41].
 
5
At least in an abstract manner through the social contract, people agree to participate in the common life; particularly, in a democratic polity, ideally people have been entitled to the opportunity to voice, to vote, and even to leave the community.
 
6
Yeh has reported preliminary qualitative findings [62], which to our knowledge is the closest available one. Other few studies have covered health sector solidarity in Taiwan, but may not serve as directly evidence [22, 32, 65]. Further researches are needed to better investigate this phenomenon and monitor the current status of health sector solidarity in Taiwan.
 
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Metadaten
Titel
Solidarity with Whom? The Boundary Problem and the Ethical Origins of Solidarity of the Health System in Taiwan
verfasst von
Ming-Jui Yeh
Chia-Ming Chen
Publikationsdatum
29.04.2020
Verlag
Springer US
Erschienen in
Health Care Analysis / Ausgabe 2/2020
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-020-00397-8

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