People line up patiently to buy medical masks in a pharmacy in Taiwan. They hand in their National Health Insurance (NHI) Cards to the pharmacist at the counter one after another. The pharmacist then inserts the NHI Card into the card reader, verifies the identity of the cardholder, and hands out the masks. Each purchase is completed within 10 seconds.

The scene has been constantly seen around Taiwan ever since the name-based mask rationing system was implemented in February 2020, when Taiwan’s Central Epidemic Command Center (CECC) enlisted help from NHI-contracted pharmacies and the NHI MediCloud System, using NHI Cards and the “NHI Express App” for identity verification and order control to make basic protection available for every citizen. Today, even after domestic retail sales of medical masks resumed in June 2020, this system is still in operation.

In addition to the name-based mask rationing system, the NHI system is also a critical first line of defense against the COVID-19 pandemic. After the COVID-19 outbreak in 2020, the CECC immediately connected the NHI MediCloud System to the border entry database. When medical staff accessed the NHI Cards of the public, they immediately learnt of travel histories, occupations, contact and cluster histories. This reduced contact risks for front-line medical personnel and allowed traffic to be diverted in time to prevent nosocomial infection.

These are the results of the digitalization of the NHI system following its establishment around the turn of the century. Today, the process of reporting medical expenses in hospitals has been fully automated, and the data are consolidated for automated review. Since the NHI Administration began issuing NHI Cards in 2004, medical personnel have been able to obtain diagnostic data of those seeking treatment simply by accessing the card. The establishment of the NHI MediCloud System in 2015 further allows medical staff to instantly acquire patients’ past medical examination reports and medication records to reduce duplication of medication and waste of medical resources.

Based on these strong foundations, the NHI Administration has begun to develop its “Virtual NHI Card” system. Once completed, it will be able to improve home healthcare and rural medical services, while making access to medical records faster and safer. In the future, people in Taiwan will have the option to use a virtual NHI Card instead of a physical one.

As the NHI offers universal coverage, in 2018, the National Development Council invited the NHI Administration and Cabinet-level Public Digital Innovation Space (PDIS) team to jointly organize three collaborative meetings. The purpose was to gather ideas from various stakeholders including medical workers, NHI users and front-line staffers issuing NHI Cards, to identify methods and risks for NHI Card virtualization.

The 2020 virtual card pilot project was based on the consensus derived from participants in the collaborative meetings, including:

  • Co-existence: The current system for physical NHI Cards will remain, while virtual NHI Cards will be developed gradually.
  • Field trial: A test run of the virtual card system will be conducted before deployment.
  • Focus on health: Extra functions such as electronic payment will not be included.

Participants in this pilot project only needed to verify their identities before displaying their virtual NHI Cards on mobile devices to be used in participating institutions. A total of 2,633 people from various backgrounds joined in scenario testing, among which 1,902 people actually used the virtual NHI Cards for hospital visits. A wide variety of institutions participate in the pilot project, including medical centers, clinics, pharmacies, district health centers, and even individual cases of home care.

A survey conducted after the pilot program showed that 83% of the participants are willing to apply for a virtual NHI Card in the future. More than 70% believe that the privacy protection mechanism is secure. The third phase of the pilot project will begin this year, aiming to develop an offline time-stamp mechanism and to expand the Virtual NHI Card system to home care and remote diagnosis and treatment.

Taiwan’s NHI system is internationally celebrated as one of the model systems of national health insurance. During the COVID-19 pandemic management operations last year, the success of the NHI MediCloud System was clearly demonstrated. While making significant changes to the NHI system, Taiwan has shown the world that “involving citizens in policymaking” is how next-generation health services can be co-created through the path of Open Government.