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This work examines health reform in the Netherlands and Taiwan to understand why these two countries set out on a different reform trajectory, despite having the similar policy goals of realizing universal access and cost control through the introduction of a nation-wide compulsory health insurance. Both the Netherlands and Taiwan initiated health reform in the 1980s and successfully implemented reform in 2006 and 1995 respectively. Both countries had different health insurance schemes, which were integrated into one unified scheme upon the reform. A key difference between the reform design was the administration of the unified insurance scheme. The Netherlands created a unified insurance scheme under the private management of health insurers. The rationale was that competition among and between private insurers and health providers would increase the efficiency of the health system. Taiwan created a unified insurance scheme under the public and central management of the government. The rationale was that this would enhance administrative efficiency and give the government greater bargaining power vis-à-vis the medical profession. This work takes a historical-institutionalist approach to examine the different reform designs. It examines how the reform in both countries was the outcome of different institutional developments over time. These different institutional dimensions are highlighted through four analytical dimensions: state-society relationship; vested interests; administration and financing of the health insurance system; and policy-making process. The Netherlands historically gave priority to private initiative in the implementation of social health insurance. The state and societal actors shared responsibility for health governance; and public and private elements were intrinsically linked in the health system. Authoritarian governance shaped the features of the social health insurance system in Taiwan. The state-initiated health insurance schemes and administered them through central government bureaus; societal actors were excluded. It is argued that these broad differences explain the different reform designs.

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