President Lai Ching-te announced that the Ministry of Health and Welfare will launch a "Health Coin" in October to encourage preventive medicine

◎ Chen Xiuan

When President Lai Ching-te chaired the Healthy Taiwan Promotion Committee on August 27, he announced that the Ministry of Health and Welfare will launch a "Health Coin" in October to encourage the public to accept adult health examinations, cancer screenings, vaccinations and health management through digital technology and incentive mechanisms. In the first phase, people over the age of 18 can participate. Adult health examinations can earn health coins, and cancer screenings also provide rewards based on different items. After accumulation, they can be exchanged for health-related goods or services.

President Lai Ching-te recently chaired a meeting of the Healthy Taiwan Promotion Committee and announced that the Ministry of Health and Welfare will officially launch the "Health Coin" policy in October. (Extracted from the presidential palace live broadcast)

For a long time, when we talk about health insurance reform, we often focus on the increase in medical expenditures, health insurance point values, drug prices, and premium burdens. However, most of these are still issues of how to allocate resources "after the disease occurs." A truly forward-looking medical policy should go one step further and ask: Can the government reduce the incidence and severity of diseases through public policies?

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The health currency policy background announced by the Ministry of Health and Welfare shows that seven of the top ten causes of death in Taiwan are chronic diseases. About 85% of the population over the age of 65 suffers from at least one chronic disease. In 2024, medical expenditures for three high-risk diseases related to the disease reached 177.9 billion yuan. Hypertension, hyperglycemia, and hyperlipidemia often have no obvious symptoms in the early stages, and people may not be checked for years until they enter the medical system after a stroke, myocardial infarction, or kidney disease occurs. At this stage, the country has to pay not only medical expenses, but also disability, long-term care, labor loss and family care costs. From the perspective of public economics, the policy benefits of one dollar invested in preventing disease and one dollar invested after the disease occurs cannot be measured by the same concept of "medical expenditure".

Therefore, what is truly worthy of recognition for health coins is that the government has begun to use "behavioral incentives" to change health policies. Traditional public policy often assumes that as long as people are told that smoking is bad, that they should exercise, and that they should receive cancer screenings, people will naturally take action. However, behavioral economics has long reminded us that people do not always make rational choices based on long-term interests. The benefits of health often occur years later, while the costs of health checkups, exercise, and screening occur today, so people tend to procrastinate. What health coins do is to transform the originally distant health benefits into small incentives that can be felt in front of you. If designed properly, this system can become an important policy tool for governments to promote preventive medicine. But for this reason, the effectiveness of the policy cannot be measured only by "how many health coins are issued" or "how many people download and use it." Instead, we should track the health examination rate, cancer screening rate, vaccination rate, and whether high-risk groups increase participation as a result. Otherwise, health coins can easily turn from a health policy into another consumption point system.

The first wave of health-care behaviors that can earn health coins. (File photo, reporter Luo Bi Tabulation)

More importantly, health coins must avoid creating new “health inequalities.” People who are most likely to complete physical examinations, exercise, and use digital tools are often those with higher health awareness and stronger information capabilities. Those who are more likely to miss screening and chronic disease management may instead be rural residents, economically disadvantaged people, elderly people living alone, and those with poor digital skills. Legislators have reminded today that if health coins are mainly operated by mobile phones or computers, some elderly people and people in rural areas may face new barriers to use. Therefore, Health Coin cannot just build an App and wait for the public to join. In the future, the Ministry of Health and Welfare should integrate health clinics, community pharmacies, medical institutions, long-term care centers and local governments to establish a physical assistance mechanism; it may even consider providing higher incentives for high-risk groups who have not received health examinations or cancer screenings for a long time. Policy resources should not be spread evenly, but should be given priority to those who most need to be "recovered from the medical system." This is in line with the health equality emphasized by public health.

If the health coin only allows people to "take a health check and receive points", its policy value will be limited; but if the government uses it to establish a long-term system from health check-ups, risk identification, life improvement to chronic disease management, it may become an important turning point in Taiwan's medical policy. What Taiwan was most proud of in the past was the establishment of universal health insurance so that people could afford to see a doctor when they got sick. The greater challenge in the next stage is to establish a health system that allows people to "get sick less often, get sick later, and not get so seriously ill." The sustainability of health insurance cannot always only discuss how much income to increase and how much expenditure to control. We should also think about how to reduce the burden of disease from the source. Therefore, health coins should not be just welfare policies, nor should they be reduced to short-term points activities, but should be regarded as a policy experiment in preventive medicine. In the past, the government's largest medical expenditure was on trying to cure people after they became ill; in the future, a smarter health policy should be to invest in keeping people healthy while they are still healthy.

The sustainability of health insurance should consider how to reduce the burden of disease from the source; health coins should not just be welfare policies, but should be regarded as a policy experiment in preventive medicine. (File photo)

(The author is a master's degree from National Taiwan University School of Medicine)