【Column Article】CommonHealth｜Cancer Medical Expenditures Double in 11 Years, While the Number of Patients Rises by 55%: Former NHIA Director-General Says Taiwan’s Cancer Prevention Strategy Is Still Missing a Crucial Link
Cancer Medical Expenditures Double in 11 Years, While the Number of Patients Rises by 55%: Former NHIA Director-General Lee Po-Chang Says Taiwan’s Cancer Prevention Strategy Is Still Missing a Crucial Link
Over the past 11 years, Taiwan’s National Health Insurance (NHI) spending on cancer has doubled, while the number of cancer patients has surged by 55%. Former Director-General of the National Health Insurance Administration (NHIA), Lee Po-Chang, points out that in response to the Chung Lien edible-oil carcinogen incident, rather than focusing solely on penalties after the fact, we should recognize that cancer is the cumulative result of exposures throughout a person’s lifetime. Truly successful policy does not simply wait for people to become ill and then provide treatment; it reduces health risks before disease occurs.
Updated: August 13, 2026
By Lee Po-Chang
Managing Editor: Liao Bi-Jun
Source: Web only
Image source: Shutterstock (illustrative image)
For more than 40 years, I have worked as a surgeon. I also served as Director-General of Taiwan’s National Health Insurance Administration for six years and eight months. From the operating room to the NHIA, I have continually reflected on the same question: What can healthcare truly do for the people?
In the operating room, I worked to remove cancers and extend patients’ lives. At the NHIA, I worked to establish a healthcare system that was fairer and more efficient. However, after leaving the NHIA, I have come to realize more deeply that what truly determines a nation’s health is not healthcare alone, but also the environment in which people live every day.
Recently, the Chung Lien edible-oil incident has attracted considerable public attention. Much of the media discussion has focused on whether the products should be recalled, whether the government was too slow to disclose the information, whether the central or local government should be held responsible, and whether the penalties were sufficient.
Yet I have continued to think about another question: If we truly want to reduce the incidence of cancer, are we focusing on the wrong things?
President Lai Ching-te has proposed the vision of a “Healthy Taiwan,” with the goal of reducing cancer mortality by one-third in the future. This is a national objective worthy of broad public support. However, achieving it will require more than cancer treatment. More importantly, we must answer a fundamental question:
Where does cancer come from?
Why Are the Number of Cancer Patients Still Increasing Despite Greater Investment in Treatment?
During my tenure as Director-General of the NHIA, what I saw each year was not a decline in the number of cancer patients, but a continued increase. Cancer-related healthcare expenditures were not falling either; they continued to rise year after year.
According to NHIA data, over the past 11 years, the number of people receiving cancer treatment increased from approximately 630,000 to 970,000, an increase of about 55%. Cancer-related healthcare expenditures rose from more than NT$70 billion to more than NT$150 billion, nearly doubling. Spending on cancer drugs increased even more sharply, from approximately NT$18 billion to more than NT$40 billion, more than doubling over the same period.
On the one hand, these figures reflect the growing need for cancer treatment and demonstrate the NHI system’s willingness to invest greater resources in caring for patients. On the other hand, they also remind us of a more alarming fact: the number of cancer patients continues to rise.
For more than 40 years, cancer has remained the leading cause among Taiwan’s top 10 causes of death. More than 100 people die from cancer every day. Behind every patient is a family affected by the disease, as well as a substantial medical burden on the NHI system.
Therefore, I have always believed that a truly successful cancer policy is not simply one that helps cancer patients live longer, but one that enables more people to avoid developing cancer in the first place.
A Crucial Link in Cancer Prevention: Stop Risks Before Disease Occurs
Ten years ago, when I had just assumed the position of NHIA Director-General, I told all my colleagues:
“The role of the NHIA is to enable healthcare, not to manage physicians.”
This statement later resonated with many people in the medical community because the purpose of government is not to increase administrative controls, but to establish a system in which professionals can fully exercise their expertise and people can genuinely benefit.
Today, I still believe that the same principle applies to cancer prevention and control.
The government’s role is not merely to treat disease; it should also enable health.
Healthcare can only ever follow disease. What can get ahead of disease is public health, disease prevention, health promotion, and the reduction of avoidable health risks.
If a country’s cancer policy focuses exclusively on investing in more new cancer drugs, establishing more cancer centers, and allocating more medical resources, while failing to pay equal attention to the causes of cancer, then even the best healthcare system will ultimately be forced to run endlessly after the disease.
Cancer Does Not Suddenly Appear—it Is the Result of Cumulative Lifetime Exposure
Modern medicine has long recognized that cancer is not caused by a single exposure or formed overnight. Rather, it is the result of long-term interactions among multiple risk factors.
In addition to aging, risk factors may include smoking, alcohol consumption, betel nut chewing, obesity, hepatitis B and C viruses, human papillomavirus (HPV), air pollution, occupational exposure, ultraviolet radiation, and certain carcinogens in food.
In recent years, the international public health community has increasingly emphasized the concept of the exposome, which suggests that health is influenced not only by genes but also by the totality of a person’s environmental, dietary, infectious, lifestyle, and medical exposures throughout their lifetime, beginning at birth.
In other words, a single barbecue meal, one cigarette, one episode of air pollution exposure, or one medical examination involving radiation does not necessarily cause cancer immediately. However, when multiple risk factors accumulate over time, they may increase the likelihood of developing cancer.
This is also why, in recent years, I have used Taiwan’s National Health Insurance data to study medical diagnostic radiation, exploring the relationship between cumulative radiation exposure and cancer risk.
I am not opposed to medically necessary examinations. Rather, I hope that all medical interventions will follow the principle that the benefits should outweigh the risks, while unnecessary repeat examinations should be avoided in order to reduce preventable health exposures.
Original source:
https://www.commonhealth.com.tw/blog/6467
