At a Glance

  • Session: Plenary Lecture 1 (approximately 09:22-09:50)
  • Slide title: Challenges and Opportunities of National Health Policies (國民健康政策之挑戰與機會)
  • Speaker: Distinguished Investigator and Vice President, National Health Research Institutes (since January 2023); former Superintendent of Taichung Veterans General Hospital; diabetes and endocrinology specialist

Six Challenges Facing Taiwan's Healthcare System

  • A super-aged society (the pace of aging is accelerating rapidly, driving demand for home-based care)
  • Financial pressure on National Health Insurance (new drugs, cancer drugs, and rare-disease drugs are expensive)
  • The burden of chronic disease
  • Workforce shortages (driven by the low birth rate)
  • Empowering and enabling the public
  • Geographic barriers in rural areas

Chronic Disease Is Now the Top Public Health Challenge

  • Half of the top ten causes of death are chronic diseases. Chronic conditions related to high blood pressure, high blood sugar, and high cholesterol together caused 62,164 deaths a year, 30 percent of all deaths, more than cancer's 53,126 deaths, or 26 percent. The point made was that these three conditions kill about as many people as cancer does (the slide used 2023 data, which checks out against official figures) (see the Fact Check page)
  • Taiwan sees over 200,000 deaths a year nationwide (the official 2024 figure was 201,383)

Ten Years of Diabetes Care Results: TDR

  • The Taiwan Diabetes Registry (TDR) tracked patients from 2015 to 2025
  • LDL cholesterol control (under 100) had the highest and most stable rate, around 73-85 percent
  • HbA1c control (under 7 percent) kept improving, rising from about 37 percent to over 60 percent
  • Blood pressure control (under 130/80) had the lowest rate and showed no improvement over the decade, staying around 33-47 percent
  • The share of patients hitting all three targets at once (LDL-C, HbA1c, and blood pressure) - the "model students" - rose from about 11 percent a decade ago to about 20 percent now

Policy Target: The 888 Plan and Healthy Taiwan KPIs

  • The "888 Plan" for controlling high blood pressure, high blood sugar, and high cholesterol: get 80 percent of patients into a care network, 80 percent receiving lifestyle counseling, and 80 percent hitting control targets (the official target year is 2030; the slide also listed a "2028 Target" as an interim KPI from the Healthy Taiwan Promotion Committee. As of November 2025: 60.7 percent enrolled in the network, 49.5 percent receiving counseling, 54.6 percent at control)
  • Supporting measures: lowering the age for adult preventive health checkups to 30, raising the subsidy from NT$520 to NT$880, and targeting people at high risk for metabolic syndrome; Family Medicine Integrated Care 2.0, expanded SGLT2 inhibitor coverage, a family medicine platform, and AI-personalized health education
  • Care pathway: Expanded Screening, then Risk Stratification, then Precision Education, then Precision Care

Precision Medicine Infrastructure: Three Layers of Databases

  • Taiwan Biobank (community-based): has enrolled 200,000 people, with a third round of call-backs underway
  • TPMI, the Taiwan Precision Medicine Initiative (a partnership between Academia Sinica and hospitals, hospital-based): originally aimed to enroll 1 million people but reached about 500,000 due to funding constraints. The speaker said a second phase is underway, re-consenting 300,000 previous participants plus enrolling 200,000 new ones (public information doesn't yet confirm this "second phase," so this is noted as the speaker's stated claim)
  • NBCT, the National Biobank Consortium of Taiwan (established 2019, an integration platform): brings together 33 databases nationwide, with 939,000 registered records covering 563,000 unique individuals, and is already used by 15 international pharmaceutical companies (as stated in the talk)

Academic output: around the same period in 2025, TPMI produced two Nature papers and one Nature Communications paper, covering polygenic risk scores for the Han Chinese population and pharmacogenomics (see the Fact Check page).

Central Case Study: CKM/CKLM Syndrome

Data source: a large Taiwanese health-checkup cohort study (over 515,000 people, followed for 16 years), by Tsai MK et al., published in PLoS Medicine (2025). The key figures have been verified against the paper (see the Fact Check page).

  • 71.5 percent of those screened met the criteria for CKM syndrome; Stage 2 was the largest group at 46.3 percent; after age 55, nearly 90 percent of people fell somewhere within the CKM staging system
  • Progression was fast: with an average gap of 2.5 years between two checkups, 18.3 percent of people worsened to a more severe stage (14.3 percent improved, 67.4 percent stayed the same)
  • Risk isn't linear: people with all four risk factors had 6.68 times the cardiovascular disease risk of people with none (a figure stated verbally in the talk)
A "wait and see" approach mathematically guarantees irreversible stage progression for nearly 1 in 5 patients within 30 months.

CKM is evolving into CKLM: MASLD (metabolic dysfunction-associated steatotic liver disease, or fatty liver linked to metabolism) is being folded into the American Heart Association's staging system. The new model treats the heart, kidney, liver, and metabolic system as one connected network rather than four separate organs. SGLT2 inhibitors and incretin-based drugs (GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists) can protect all four organ systems at once, making them a key pharmacological opportunity for integrated care.

Three policy levers (drawing on Ndumele CE's 2023 paper in Circulation and the T-CaReMe Consortium framework):

  • National Health Insurance coverage that supports multidisciplinary integrated clinics
  • Shifting resources toward early prevention and social determinants of health (SDOH)
  • Digital infrastructure: remote monitoring, wearables, and interoperability between electronic health records (EHR) and registries

The National Health Research Institutes is bringing together kidney, lipid, and cardiology societies to jointly develop care guidelines, and is collaborating internationally with experts from Japan, South Korea, and Hong Kong.

Policy Vision and Notes

This aligns with the "Healthy Taiwan" policy. With its healthcare capacity and integrated governance, Taiwan can become a global benchmark for integrated CKM care, establishing chronic disease governance as Taiwan's second national strategic pillar.

Note

The percentage of Taiwan's population aged 65 and over stated verbally in the talk did not match the official figure (20.06 percent as of the end of 2025). This may be a slip of the tongue or a note-taking error, and the official figure should be treated as authoritative (see the Fact Check page).