The Committee welcomes President Lai Ching-te’s Healthy Taiwan initiative as a timely and comprehensive program to advance the health and wellbeing of citizens across all age groups. This initiative introduces comprehensive reforms centered on preventive care, chronic disease management, digital health integration, and expanded mental health services. Moreover, the establishment of the Healthy Taiwan Promotion Committee provides a valuable platform for inter-agency coordination, policy planning, and stakeholder dialogue on health-related initiatives. We commend the government for its commitment to fostering a holistic and proactive approach to healthcare.

Over the past year, the Committee has observed notable progress in the government’s willingness to engage in meaningful public-private dialogue and to incorporate input from industry stakeholders into the policy development process. These engagements have helped shape policies that are better aligned with clinical realities, technological innovation, and system sustainability.

As Taiwan prepares for a demographic shift that will strain public health financing and capacity, ensuring a resilient, innovation-friendly, and patient-centered healthcare system has become an urgent national priority. The Committee appreciates the authorities’ receptiveness to its past White Paper recommendations and views this collaborative approach as a cornerstone for future progress.

To build on this momentum, the Committee encourages the government to further institutionalize mechanisms for public-private partnership to ensure regular, structured consultation throughout the policymaking and implementation process. We also recommend that the government increase investment in healthcare reimbursement funding to improve patient access and system capacity. Additionally, advancing the integration of evidence-based, patient-centered innovations into the National Health Insurance (NHI) framework is critical to meeting the evolving healthcare needs of Taiwan’s population.

Finally, the Committee reiterates the importance of aligning Taiwan’s legal and regulatory standards with international best practices to enhance transparency, predictability, and investment attractiveness. By pursuing these priorities in partnership with the private sector, the government can strengthen Taiwan’s healthcare resilience while enhancing its position as a regional leader in patient access, innovation, and system sustainability.

Suggestion 1: Utilize public-private partnerships to advance the Healthy Taiwan agenda.

The Committee commends the government’s continued commitment to strengthening Taiwan’s healthcare system through public-private collaboration. In line with the objectives of the Healthy Taiwan initiative, we reaffirm the importance of developing a patient-centric, transparent, and sustainable health ecosystem that benefits from active stakeholder participation. To further enhance Taiwan’s healthcare resilience and competitiveness, the Committee offers the following recommendations in two key areas: communication mechanisms and clinical trial policy development.

1. Strengthen communication channels to deepen public-private dialogue. The Committee appreciates the commitment of the National Health Insurance Administration (NHIA) to convening biannual policy dialogue meetings. To enhance the impact of these forums, we recommend adopting a more structured and issue-specific agenda that allows for deeper engagement and more actionable outcomes.
   Furthermore, the establishment of dedicated working groups by the NHIA involving relevant government agencies and industry representatives would help sustain momentum on priority issues. As a reference, the United Kingdom’s collaborative framework between the National Health Service (NHS) and the Association of the British Pharmaceutical Industry (ABPI) may serve as a valuable model. This structured partnership supports healthcare innovation, improves patient outcomes, and strengthens sector resilience through continuous and transparent dialogue. We encourage Taiwan to consider adopting a similar approach to ensure that healthcare policies are developed collaboratively, implemented effectively, and aligned with long-term healthcare system goals.
2. Enhance policy development by promoting international collaboration and strengthening Taiwan’s clinical trial environment. The Committee recommends that industry representatives be formally included on the Healthy Taiwan Promotion Committee to ensure alignment with international best practices and to reflect the perspectives of multinational pharmaceutical stakeholders.
   We also urge the government to adopt targeted policies to incentivize multinational investment in Taiwan’s clinical trial ecosystem. Specific measures could include streamlining regulatory processes, strengthening infrastructure, and supporting cross-sector partnerships. These efforts would help improve the availability and timeliness of advanced therapies for patients, support the localization of global research pipelines, and elevate Taiwan’s standing in the global biomedical innovation landscape.
   While the Committee acknowledges the government’s existing mechanisms, including quarterly progress assessments on cancer screening, chronic disease management, and mental health initiatives, we believe there is an opportunity to enhance transparency and foster broader stakeholder alignment. We recommend that these performance metrics be made publicly available through official government channels. Additionally, we encourage the establishment of regular dialogue mechanisms with industry representatives and patient advocacy groups to complement these efforts. Improving access to progress data and deepening stakeholder engagement would strengthen public trust, facilitate continuous policy refinement, and contribute to the development of a more innovative and resilient healthcare system.

Suggestion 2: Ensure the sustainability of the NHI system by means of equitable funding growth and social fairness while supporting continued access to innovative therapies.

The Committee commends the achievements of Taiwan’s NHI system in delivering efficient and accessible healthcare over the past three decades. However, rapid advances in medical science, increasing treatment costs, and the accelerating pace of demographic aging have placed mounting pressure on the system’s long-term sustainability. Projections indicate that by 2040, there will be only two working-age citizens for every elderly person, down from four in 2022. This demographic shift is expected to increase per-capita healthcare expenditures, potentially doubling them compared to 2020 levels.

We acknowledge the NHIA’s interim implementation of temporary dedicated funding for cancer treatments and support its implementation of the Cancer Drugs Fund (CDF), which will have an initial budget of NT$5 billion in 2025 and plans to raise the fund to NT$10 billion over time, as a supplemental financing mechanism to reduce fiscal strain on the healthcare system, healthcare professionals, and patients.

To safeguard the NHI system’s continued viability, we emphasize the importance of expanding and diversifying investment, modernizing premium contributions, and ensuring social equity across generations. A robust public-private partnership framework will be essential for optimizing policy design, improving resource allocation, and facilitating the adoption of innovative therapies that respond to evolving patient needs. In this context, the Committee proposes the following recommendations:

1. Increase funding to support long-term sustainability. The Committee supports the objective of raising the government’s contribution to NHI financing to the statutory 36% threshold and encourages continued expansion of general budget allocations. We also recommend institutionalizing the CDF and increasing its annual funding level to above NT$10 billion to address the sustained demand for oncology therapies. Over the long term, moderate increases in insurance premium rates should be considered to reflect rising healthcare expenditures. In addition, we encourage closer integration of commercial insurance with the NHI system to broaden the funding base and enhance overall system resilience.
2. Strengthen budget planning in alignment with reimbursement policy. To ensure that NHI budget allocations more accurately reflect healthcare needs, we recommend refining the methodology for forecasting new drug expenditures. The Committee encourages greater utilization of the current prospective budget assessment system by incorporating actual drug registration volumes and expenditures into annual budget planning. Moreover, we urge the government to maintain regular dialogue with industry stakeholders to align reimbursement criteria with international clinical guidelines and patient demand. Regular and transparent communication will improve pricing predictability, facilitate market access for innovative therapies, and enhance treatment equity. Moreover, it will enable earlier planning for innovative treatments, reduce ad hoc budget pressures, and improve access predictability.
3. Ensure reasonable drug pricing reform. The Committee supports the government’s efforts to strengthen supply chain stability as part of the ongoing drug pricing reform. One key component of this reform is the Drug Expenditure Target (DET) mechanism, which sets an annual ceiling on total drug spending and adjusts drug prices downward when actual expenditures exceed that target. While originally introduced to control costs, the current DET model can result in price volatility and misalignment with actual pharmaceutical usage, discouraging continued product availability and investment.
   In preparation for revisions to the DET mechanism, we recommend adjusting the baseline value to reflect actual pharmaceutical expenditure rather than outdated or artificially constrained targets. This approach would reduce the frequency and severity of pricing cuts, support healthy product lifecycle management, and maintain stable supply. A more predictable and fair pricing environment would not only help prevent shortages but also foster long-term investment in Taiwan’s pharmaceutical market and ensure a continuous pipeline of innovative therapies for patients.

By implementing these recommendations, the government can reinforce the NHI system’s sustainability while preserving equitable access to high-quality medical treatments.

Suggestion 3: Promote transparent, predictable, and globally aligned healthcare regulations.

The Committee remains committed to partnering with the authorities to support sound regulatory implementation and ensure a transparent, stable, and investment-friendly healthcare environment. We commend the government’s continued efforts to align regulatory practices with international standards and to create a predictable legal framework. In particular, we welcome the NHIA’s practice of providing full 60-day public consultation periods for major regulatory revisions and its engagement in two-way communication both before and after public announcements. These developments mark important progress toward inclusive and transparent policy development.

To further strengthen Taiwan’s position as an attractive market for healthcare investment, we recommend deepening dialogue on the following issues:

1. Strengthen regulatory impact assessments to improve transparency and predictability. We commend the government’s efforts to harmonize regulations and to require regulatory impact assessments (RIAs) for policies expected to have significant economic or stakeholder impact (defined by the Taipei Economic and Cultural Representative Office as exceeding NT$6 billion). We further support the inclusion of alternative policy options and summaries of stakeholder feedback during public consultation periods.
   To enhance policy implementation and alignment with international good regulatory practices, we recommend extending these RIA practices to major upcoming reforms, particularly the DET revision. Early publication of policy objectives, detailed impact assessments, and ongoing public-private dialogue, as exemplified by the RIA frameworks in the United States and the United Kingdom, where RIAs are legally required and typically include clear problem definitions, impact analysis, and robust stakeholder consultation, would ensure a smoother transition and support Taiwan’s healthcare system goals.
2. Enhance transparency and stakeholder engagement. We appreciate the NHIA’s emphasis on stakeholder engagement in the implementation of systems such as Managed Entry Agreements (MEAs) and Health Technology Reassessment (HTR). Moving forward, we recommend that public consultations move beyond the collection of stakeholder comments to include the publication of a summary of input received, an explanation of how it was considered, and the rationale for final decisions. Such transparency would showcase a dedication to transparent and democratic practices.
   We further recommend that MEA policy implementation uphold fundamental contractual principles, including fair risk-sharing mechanisms, mutual benefit, evidence-based assessment, and confidentiality. As HTR outcomes have broad implications for patient rights and access to care, the framework should be grounded in clear legal authority and supported by a mechanism for two-way communication. Doing so will improve both policy feasibility and stakeholder trust.

By adopting these recommendations, Taiwan can ensure continued alignment with global best practices in regulatory governance. Moreover, it will support sustainable healthcare development, facilitate equitable patient access to innovative therapies, and enhance Taiwan’s attractiveness as a destination for life sciences investment.