health and improving the efficiency and accessibility of Taiwan’s healthcare system. We appreciate the Ministry of Health and Welfare (MOHW) for proactively engaging with industry and strongly considering our recommendations over the past year. Moreover, the Committee welcomes the ambition of President Lai Ching-te’s Healthy Taiwan initiative, which outlines long-term goals for strengthening the nation’s health outcomes.

In support of these shared objectives, the Committee offers the following recommendations:

Suggestion 1: Strengthen chronic disease risk stratification and establish a patient-centric multi-morbidity care network.

Chronic diseases continue to place a growing burden on Taiwan’s healthcare system, contributing significantly to rising medical expenditures and long-term public health challenges. To support the goals of the Healthy Taiwan initiative, the Committee recommends that the government further prioritize resource allocation toward high-risk populations, establish a risk-based stratification system, and implement a patient-centered comorbidity care network. These measures would help improve care coordination and enhance public health outcomes.

1. Adopt a risk-based stratification model. A central goal of the Healthy Taiwan initiative is to reduce the number of unhealthy years for individuals, with a target of lowering the standardized mortality rate of chronic diseases by one-third by 2030. To support effective use of healthcare resources, the Committee recommends adopting a risk-based stratification model that prioritizes active case management for high-risk individuals. For example, in the case of atherosclerotic cardiovascular diseases, a risk-based approach would involve identifying patients with relevant medical history or coexisting clinical conditions and integrating them into a structured care network. Within this framework, individualized treatment goals and active follow-up mechanisms should be implemented to support continuous care and ensure patients achieve optimal health outcomes.
   Despite its well-documented links to chronic diseases, Taiwan’s adult overweight and obesity rate has risen sharply, from 44.8% in 2013 to 50.8% in 2023. Elevated body mass index (BMI) is an independent and recognized risk factor for long-term metabolic conditions, including diabetes, hypertension, and cardiovascular disease. In light of this concerning trend, the Committee recommends designating overweight (BMI 24.0–26.9) and obese (BMI ≥ 27.0) individuals as priority groups under the Family Doctors’ Plan 2.0.
   While BMI is currently utilized only within the Metabolic Syndrome Management Program, we recommend broadening its application and incorporating waist circumference (another critical, non-interchangeable metric) to improve risk stratification. This integrated approach would enhance the precision of risk identification and enable early intervention through a continuum of care, including nutritional counseling, physical activity prescriptions, behavioral therapy, and, where appropriate, pharmacological treatment.
   To support the Healthy Taiwan initiative and achieve the 2030 target of reducing the adult overweight and obesity rate to 44.8%, a more proactive and comprehensive national weight management policy is urgently needed.
2. Strengthen screening initiatives for high-risk kidney disease individuals. Taiwan has a chronic kidney disease (CKD) prevalence rate of 12%, with an increasing share of cases linked to diabetes-related nephropathy. Among newly diagnosed dialysis patients, 20% develop heart failure within three years, and nearly half of annual dialysis-related deaths are associated with heart failure. These figures highlight the need for an integrated cardio-renal-metabolic (CRM) holistic care network to improve multimorbidity management.
   The Committee recommends that the Healthy Taiwan initiative be proactive in prioritizing early screening and intervention to facilitate timely identification of high-risk individuals. It should also integrate resources across ministries and healthcare systems by consolidating health data from student checkups, workforce health screenings, and adult preventive care programs. Strengthening the use of these screenings would support a multidisciplinary care model focused on continuous disease monitoring, effective primary and secondary prevention, and more targeted therapeutic investment. Early intervention, enabled by a robust CRM holistic care network, will be critical to reducing chronic disease mortality and improving long-term patient outcomes.

Suggestion 2: Strengthen disease prevention, early diagnosis, and intervention for the elderly to prolong healthy life expectancy.

According to estimates by the National Development Council, annual medical expenses for individuals aged 65 and older are projected to exceed NT$620 billion (US$20 billion) by 2050, underscoring the urgent need for effective disease prevention, detection, and early intervention. As life expectancy continues to rise, the Committee recommends that efforts to reduce the incidence of geriatric diseases be prioritized through early detection and targeted care, in line with the Healthy Taiwan policy objective of reducing the proportion of an individual’s life spent in poor health from 10% to 8%.

Elderly populations remain particularly vulnerable, as demonstrated by recent Covid-19 data showing that 88% of the severe cases resulting in death occurred among individuals aged 65 and above. This statistic is particularly alarming as Taiwan has entered a “super-aged” society, in which 20% of the population is aged 65 or above. While the Taiwan Centers for Disease Control (CDC) set a Covid-19 vaccination target of 40% for this demographic by the end of May 2025, the rate remained below 20% as of March 2025. Recognizing the accessibility challenges faced by many elderly individuals, the Committee recommends the following measures:

1. Introduce a paper-based Senior Health Handbook to improve vaccination coverage and health literacy. Such a Senior Health Handbook, modeled after the existing Child Health Handbook, would serve to consolidate vaccination schedules, immunization records, and educational resources into a practical, user-friendly format for elderly individuals. Many seniors prefer physical records and rely on printed materials for managing their health. Caregivers also benefit from access to a clear, accessible reference tool.
   The handbook would serve as a practical and user-friendly guide, supporting seniors in navigating preventive care and taking an active role in managing their health. By improving awareness and accessibility, this handbook can help increase annual vaccination rates and advance the broader goal of healthy aging.
2. Establish a screening-diagnosis-treatment pathway for early Alzheimer’s disease. The prevalence of dementia among individuals aged 65 and older in Taiwan is projected to exceed 10% by 2044, with Alzheimer’s disease accounting for more than half of these cases. As the condition progresses, long-term care and informal caregiving costs are expected to rise significantly, placing increased strain on families and the healthcare system.
   To address this challenge, the Committee recommends establishing a clear and accessible screening-diagnosis-treatment pathway for early Alzheimer’s disease, particularly at the mild cognitive impairment and mild Alzheimer’s stages. Early intervention at these stages is critical to delaying disease progression and supporting longer periods of healthy, independent living. This approach would contribute to the Healthy Taiwan policy goal of reducing the average duration of unhealthy life expectancy and ensuring better outcomes for aging populations.
   While Taiwan aims to ensure that 70% of people with dementia are diagnosed and supported, diagnostic tools such as the Mini-Mental State Examination and brain imaging primarily detect Alzheimer’s disease at symptomatic stages, often when the condition has already progressed to irreversible phases. In contrast, international practices are shifting toward precision medicine and early-stage detection, supported by emerging health technologies.
   The Committee recommends that the MOHW strengthen early screening and diagnosis of Alzheimer’s disease and accelerate reimbursement for new treatments. Specifically, the government should prioritize the implementation of blood biomarker screening to identify high-risk individuals and employ advanced diagnostic tools such as amyloid-PET scans and cerebrospinal fluid biomarkers to accurately detect Alzheimer’s disease in its early stages.
   Early identification enables timely intervention, which can help delay disease progression, reduce the duration of disability, and improve the quality of life for elderly individuals. Advancing this approach will also ease the caregiving burden, lower long-term care costs, and reduce the broader societal impact of the disease.

Suggestion 3: Design a post-pandemic strategy to strengthen universal vaccination and antimicrobial resistance management.  

The Committee commends the government’s national epidemic prevention and antimicrobial resistance efforts. Building on this foundation, we recommend developing a comprehensive post-pandemic strategy that reinforces prevention measures, improves long-term financial planning, and enhances the functionality of the vaccine information system.

Furthermore, integrating infectious disease control and antimicrobial resistance management into routine public health operations will strengthen Taiwan’s overall resilience against future epidemics and emerging health threats.

1. Continue ensuring that the public budget covers at least 60% of total national vaccination costs. According to the World Health Organization, high-income countries spent approximately 0.3% of their recurrent healthcare expenditure on immunization in 2019. In comparison, Taiwan only allocated about 0.2% in the same year. The Committee commends the government for its decision to increase the annual budget for routine vaccinations (excluding Covid-19 vaccines) from approximately NT$3.4 billion to an estimated NT$5 billion by 2025, a meaningful step toward strengthening national immunization efforts.
   The Committee urges the government to continue following the Public Immunity Strengthening Plan, Phase I, ensuring that the public budget covers at least 60% of total national vaccination costs. In parallel, the National Vaccine Fund Expansion should be updated without delay to reaffirm Taiwan’s long-term commitment to epidemic prevention and public health resilience.
2. Fortify vaccination for all ages. As Taiwan transitions into a super-aged society, strengthening immunization is essential. Innovative vaccines should be introduced, and pediatric vaccination programs should be prioritized and aligned with international best practices, such as those recommended by the United States, while national immunization guidelines are regularly updated.
   According to 2023 CDC data, 49.1% of individuals aged 65 and above had received at least one dose of the pneumococcal vaccine. However, pneumonia has remained the third-leading cause of death in Taiwan for six consecutive years. Influenza vaccine coverage for this age group was only 50% in 2024, significantly lower than South Korea’s 80%. The Committee recommends expanding vaccine access and coverage for older adults to reduce preventable illness and mortality, and to support Taiwan’s broader healthy aging goals.
   We recommend that the CDC proactively publish vaccination rates and pneumococcal serotype data for the elderly portion of the population. As the invasive pneumococcal disease mortality rate reaches as high as 60% among individuals aged 65 and older, timely and transparent data are essential to inform policy and improve outcomes.
   In addition to implementing targeted reminder strategies, the Committee urges the MOHW’s Department of Long-Term Care, in coordination with the CDC, to establish a national pneumococcal prevention and vaccination strategy.
3. Integrate public and private vaccination data to improve coverage and access. The Committee recommends linking National Health Insurance (NHI) records, cloud-based prescriptions, and the National Immunization Information System to consolidate vaccination data across public and private sectors.
   Streamlining access and improving user interfaces would help healthcare providers offer timely, informed recommendations and allow individuals to easily track their vaccination history. Referencing international best practices, this integration would support higher vaccination uptake and more effective public health management. To strengthen public confidence, integration efforts should also ensure robust data security measures and clear consent protocols.
   Moreover, we urge the government to establish a vaccination information integration platform for the public. Drawing on successful models from Australia, South Korea, and the United Kingdom, this platform should provide clear and comprehensive vaccine information through user-friendly websites or handbooks. By enriching the Advisory Committee on Immunization Practices guidelines and helping to incorporate innovative vaccines with high patient compliance, the Committee hopes to support the government in a collaborative effort to raise public awareness, promote informed decision-making, and increase overall vaccination coverage.

Suggestion 4: Promote the diverse application of smart healthcare to enhance resource integration and care quality.

Advancing smart healthcare technologies is essential for modernizing Taiwan’s healthcare system, improving care quality, and increasing efficiency. The Committee acknowledges the MOHW’s efforts to strengthen electronic medical records, develop personal health records, and prioritize digital innovation within healthcare evaluation systems. These include encouraging intelligent management systems in medical center accreditation, promoting the use of electronic communication tools in long-term care facilities to improve caregiver coordination, and supporting various digital care initiatives under the NHI program.

By laying a strong foundation, the MOHW has enabled broader adoption and integration of smart healthcare across Taiwan’s healthcare landscape. To further enhance its scale, accessibility, and clinical value, the Committee recommends the following measures:

1. Encourage the expanded implementation of smart healthcare and various evaluation trials or incentive programs. Encourage healthcare institutions and long-term care facilities at all levels to enhance the quality of medical care, patient safety, and operational management outcomes. Actively promote data sharing among institutions to facilitate service and caregiving integration across institutions, as well as the development of telemedicine and home healthcare.
2. Promote the transformation of home healthcare and the application of self-care platforms at home. Strengthen healthcare professionals’ ability to apply smart healthcare tools in clinical settings while increasing public awareness to boost acceptance and encourage patient participation in self-health monitoring and management. Incorporating patient experience feedback and satisfaction surveys will help identify areas for improvement and support the delivery of higher-quality, more patient-centered care. These efforts are essential to advancing smart healthcare adoption and fostering greater patient engagement.
3. Provide incentives and strengthen reimbursement mechanisms to accelerate smart healthcare adoption. The Committee recommends offering tangible rewards, ranging from accreditation ratings or certification awards to financial incentives, to outstanding institutions and healthcare professionals to promote healthy competition and recognize excellence in smart healthcare implementation. More importantly, increasing the budget for smart healthcare reimbursements and enhancing the predictability of market access for digital medical tools will be key to accelerating adoption and ensuring long-term sustainability.

Suggestion 5: Enhance cancer prevention and treatment to align with international standards and reduce mortality.

Cancer remains Taiwan’s leading cause of death. The Committee supports President Lai’s goal of reducing cancer mortality by one-third by 2030. To further strengthen cancer prevention and treatment efforts, we offer the following recommendations:

1. Establish clear cancer screening and treatment targets to advance the Healthy Taiwan vision. The Committee urges the government to set specific benchmarks for cancer screening and treatment rates, tailored to each cancer type and form of treatment. Enhancing screening coverage, increasing funding, and strengthening resource allocation will be essential to improve early detection and reduce cancer mortality.
   The planned NT$6.8 billion cancer-screening budget for 2025, up from NT$2.8 billion, reflects the government’s commitment to expanding screenings for Taiwan’s five major cancers (lung, colorectal, breast, cervical, and gastric) and adopting new diagnostics. While this increase is a welcome development, raising screening participation remains a key challenge. MOHW data shows that only cervical cancer screening has surpassed a 50% participation rate, with breast and colorectal cancer screenings consistently falling below 40%. The Committee urges the MOHW to develop cancer-specific strategies aimed at increasing screening participation, improving the allocation and utilization of screening resources, and ultimately reducing cancer-related mortality. Tailored approaches should reflect the epidemiological characteristics and care pathways of individual cancer types, with an emphasis on early detection and equitable access.
   The World Health Organization estimates that 30% to 50% of cancers are preventable. To strengthen its cancer prevention efforts, Taiwan should enhance the tracking of new cases by type and establish performance indicators such as follow-up, treatment initiation, and survival rates. These metrics will help improve integration of screening, diagnosis, and treatment, while also providing a clear basis for evaluating the effectiveness of national cancer prevention policies.
2. Align cancer treatment with international benchmarks. Taiwan faces persistent gaps in cancer care relative to international benchmarks. Major challenges include delayed access to new therapies, limited reimbursement coverage, constraints on treatment timing and duration, higher out-of-pocket costs for patients, and reduced clinical trial participation due to misalignment with global standards.
   The Committee welcomes the government’s Cancer Drug Fund (CDF), a critical policy tool designed to accelerate patient access to innovative cancer therapies and reduce the treatment gap between Taiwan and international standards. In 2025, NT$5 billion was allocated from the national budget to support the fund, with a planned gradual increase to NT$10 billion. The CDF plays a critical role in supporting access to new drugs or indications that address unmet medical needs and show therapeutic potential, but for which clinical benefit or financial impact remains uncertain, particularly during the collection of real-world data.
   The Committee also recognizes the government’s ongoing efforts to assess and address disparities in access to treatment, particularly for lung, breast, and colorectal cancers. We recommend that the government develop strategies to improve long-term outcomes and quality of life.
   For instance, while 90% of breast cancer cases detected through screening are early stage, five-year survival rates for Stage 2 and 3 patients are declining. This pattern is not unique to breast cancer, but in all high-mortality cancers. Delayed access to early-stage treatment and limited long-term support contribute to poor outcomes and recurrence. The Committee recommends investing in adherence programs, such as dedicated nurse navigators, follow-up reminders, and co-pay subsidies for ongoing treatment, to improve outcomes and reduce avoidable mortality.
3. Strengthen implementation of the CDF through clear targets, transparent processes, and sustained collaboration. To fully realize the objectives of the CDF, the Committee urges the government to consider including drugs with compelling early-phase evidence but uncertain financial impact under well-defined conditional access programs. We recommend that the government define annual targets, assess resources, and establish a public-private platform to support implementation. In addition, we encourage the government to swiftly amend the Cancer Control Act to formalize the CDF framework and establish a clear mechanism for integration with NHI coverage.