Health Insurance, Medicine, and Society in Taiwan: Chinese Authoritarianism, Taiwanese Ethnicities, and Global Actuarial Science

Abstract

This article explores the history of the Chinese Nationalist Party (Kuomintang KMT) government’s expansion of health insurance in Taiwan from 1950 to the 2010s through the lens of ethnicity, politics and medicine. I argue that the KMT party-state’s expansion of health insurance privileged government employees and laborers, who were the core supporters of the ruling party. By comparing the history of the insurance programs for government employees, the article makes the case that KMT provided better coverage, lower premiums, and less medical gatekeeping for Chinese waisheng government employees who fled to Taiwan with the KMT than for ordinary Taiwanese bensheng laborers. Global actuarial science experts from the United Nations International Labor Organization also buttressed such a discriminatory process. This China-centered approach towards universalizing healthcare on the island became increasingly challenged by provincial legislators, labor activists, and the emerging political opposition that promoted local Taiwanese concerns on healthcare equity and access. This article concludes that this dual process of KMT’s population management and leveraging of United Nations actuarial expertise as the Republic of China became symbolic of the bio-geopolitics that animated the history and development of health insurance in Taiwan.