【Opinion】Common Health Magazine｜The Regret of Treatments That Came Too Late Became Taiwan’s National Health Insurance Safety Net: Lee Bor-jang—Don’t Let Silent Hepatitis C Take Away Your Loved Ones
The Regret of Treatments That Came Too Late Became Taiwan’s National Health Insurance Safety Net: Lee Bor-jang—Don’t Let Silent Hepatitis C Take Away Your Loved Ones
“Some regrets stay with you for a lifetime.” Former Director-General of Taiwan’s National Health Insurance Administration and renowned kidney transplant surgeon Lee Bor-jang reflects on the painful memories of watching patients succumb to hepatitis C because effective treatments were unavailable at the time. The most dangerous aspect of hepatitis C is its silence—it can remain undetected for 20 years before leading to liver cancer. Under his leadership, Taiwan established dedicated National Health Insurance funding and a cross-specialty care network. Today, highly effective oral antiviral therapies can cure hepatitis C in the vast majority of patients. He urges younger generations to ask their parents and grandparents about hepatitis C and to encourage them to undergo screening before it is too late.
Updated: June 30, 2026
By: Lee Bor-jang
Editor: Liao Bi-jun
Patients who undergo kidney transplantation require lifelong outpatient follow-up and must take immunosuppressive medications according to strict protocols.
Around 2005 and 2006, two colleagues entrusted me with the care of their family members, both of whom underwent kidney transplantation. To me, they were more than ordinary patients—they represented profound trust and responsibility. Both had chronic hepatitis C but showed no obvious liver dysfunction at the time. Based on the medical knowledge available then, patients with hepatitis C had successfully undergone kidney transplantation and remained stable. Both surgeries were successful, and we believed they had finally escaped dialysis and could begin a new chapter in life.
Unexpectedly, hepatitis C progressed rapidly. One patient developed severe liver failure nine months after transplantation, and the other only four months after surgery. Both ultimately died of liver failure.
Hepatitis C Is Often Silent, Remaining Hidden for Decades
These experiences have remained one of the deepest sorrows of my career. I understand that medicine is limited by the knowledge of its time, and every medical decision must be viewed within the scientific context in which it was made. Yet every patient’s death brings immeasurable grief to a family and leaves a lasting regret in a physician’s heart.
Whenever I see how far hepatitis C treatment has advanced today, I cannot help but wonder: if the safe, effective, and convenient medications available now had existed back then, perhaps the outcome would have been different.
The greatest danger of hepatitis C is not its severity at the beginning, but its silence. Decades ago, particularly in rural Taiwan, public health conditions were far less developed. Many older adults received injections, intravenous infusions, or invasive procedures during an era when sterilization of needles and medical equipment was inadequate, unknowingly becoming infected with hepatitis C.
After infection, many people experience no symptoms, and their liver function may appear normal for years. As a result, they receive neither follow-up care nor treatment. However, the hepatitis C virus continues damaging the liver even when patients feel perfectly healthy. It may remain quietly in the liver for 10, 20, or even more years, gradually causing chronic inflammation, fibrosis, cirrhosis, and eventually liver cancer. By the time symptoms such as ascites, jaundice, gastrointestinal bleeding, or liver cancer appear, treatment options are often much more limited.
From Difficult Treatments to a New Era of Cure
Treating hepatitis C used to be extremely difficult. Interferon injections caused significant side effects, including fever, fatigue, depression, and reduced blood cell counts. Many patients were frightened by the treatment itself, and physicians often had to balance treatment effectiveness against side effects and patient willingness. At that time, hepatitis C treatment was truly an arduous battle.
The introduction of all-oral direct-acting antiviral therapies completely transformed treatment. Patients no longer needed prolonged injections. Treatment courses became shorter, side effects were greatly reduced, and cure rates became remarkably high. For many patients, these medications represented not merely a new drug, but a turning point in life itself.
From a NT$2.5 Million Out-of-Pocket Treatment to National Health Insurance Coverage
In 2011, one of my kidney transplant patients paid approximately NT$2.5 million out of pocket to receive hepatitis C treatment. It was an enormous financial burden beyond the reach of most families. Fifteen years later, both his kidney and liver function remain excellent.
This patient left a lasting impression on me because he demonstrated how advances in medical technology can truly transform lives. Yet medical innovation is not enough if only a privileged few can afford it. That is not a complete public health policy.
In 2016, then-Minister of Health and Welfare Lin Tzou-yien directed that hepatitis C treatment be included under Taiwan’s National Health Insurance. Under the guidance of leading experts including Academicians Chen Ding-shinn and Chen Chien-jen, and Professor Jian Rong-nan, Taiwan adopted a far more proactive strategy against hepatitis C.
This was a landmark decision in national healthcare governance. Hepatitis C is not merely an individual patient’s problem—it is a public health issue affecting society as a whole. Without early treatment, increasing numbers of patients would eventually develop cirrhosis, liver cancer, and liver failure, imposing tremendous suffering on families while dramatically increasing healthcare expenditures.
Creating a Win-Win Model Through Drug Price Negotiation
A successful policy requires not only ideals but also practical implementation.
At that time, hepatitis C medications were extremely expensive, and National Health Insurance resources were limited. Fortunately, the National Health Insurance Committee approved a dedicated hepatitis C budget.
Drug pricing remained a major challenge. Minister Lin insisted that the price should not exceed NT$250,000 per treatment course, the benchmark in South Korea. I personally appealed to pharmaceutical companies to support Taiwan’s public health efforts.
This was never simply about lowering prices. Instead, we designed a win-win model: National Health Insurance expanded patient eligibility, allowing many more patients to receive treatment. Greater treatment volume ensured reasonable sales for pharmaceutical companies while making therapy affordable for the healthcare system.
Ultimately, the manufacturers agreed to NT$249,888 per treatment course. Patients benefited, future liver disease burdens were reduced, and Taiwan demonstrated that effective public policy can successfully balance medicine, finance, industry, and patient welfare through value-based healthcare.
Breaking Down Specialty Barriers to Find Patients Earlier
Another priority was ensuring these medications reached the patients who truly needed them.
Initially, hepatitis C oral antivirals could only be prescribed by gastroenterologists. However, many hepatitis C patients without symptoms rarely visit gastroenterology clinics. Instead, they routinely see physicians for diabetes, hypertension, kidney disease, orthopedics, or family medicine.
If access remained too narrow, many patients would inevitably fall through the cracks.
I therefore worked closely with hepatology specialists to establish comprehensive prescribing guidance covering indications, contraindications, and drug interactions. This provided a solid professional foundation for National Health Insurance policy.
As a result, any physician seeing a patient’s National Health Insurance records could identify hepatitis C, proactively remind the patient, and recommend further evaluation and treatment. Identifying patients is the first—and perhaps most important—step toward successful treatment.
Using Real-World Data to Improve Policy
Because these medications represented a significant investment, National Health Insurance also needed evidence that public funding was producing meaningful outcomes.
With support from professional medical societies, physicians were required to register treatment outcomes. This was far more than an administrative procedure—it created invaluable real-world evidence within Taiwan’s single-payer healthcare system.
In 2017, limited funding meant that only 8,000 patients could initially receive treatment. Registration therefore determined treatment eligibility.
One moment remains especially memorable. Physicians from the Department of Gastroenterology and Hepatology at Taipei Veterans General Hospital had already organized the records of eligible patients in advance. The moment National Health Insurance registration opened, they immediately uploaded dozens of patient records to secure treatment opportunities.
This demonstrated the extraordinary dedication of frontline physicians. No matter how well a healthcare system is designed, it ultimately depends on healthcare professionals who genuinely place patients first.
Ask Your Parents and Grandparents About Hepatitis C
Today, the message I most want to share with younger generations is simple:
Ask your parents and grandparents whether they have ever been diagnosed with hepatitis C. Have they ever tested positive for hepatitis antibodies? Have they had persistently abnormal liver function without appropriate follow-up?
The key to successful hepatitis C treatment is taking action early.
Today’s treatments are vastly different from those available decades ago. With timely diagnosis, proper evaluation, and completion of therapy, many patients can avoid cirrhosis and liver cancer.
Do not wait until symptoms appear. By then, the disease may already have progressed too far.
Clinical data from Taiwan also show that even patients who have already developed liver cancer achieve better survival after receiving hepatitis C oral antiviral therapy. This reminds us that successful treatment is not only about medication itself—it is the result of patients, physicians, National Health Insurance, and public health policy working together as a comprehensive safety net.
Throughout a physician’s career, some regrets never fade.
Helping more hepatitis C patients receive early diagnosis, timely treatment, and protection from liver failure and liver cancer has become deeply meaningful to me.
For me, advancing hepatitis C treatment has never been merely about National Health Insurance policy or drug price negotiations. It represents my response to those patients whom we could not save because effective treatment came too late.
Looking back, Taiwan’s hepatitis C elimination program stands as one of the country’s most valuable public health achievements. It demonstrates that when medical science advances, governments act decisively, and physicians actively engage with the community, an entire nation can change the course of a disease.
Do not let silent hepatitis C take away the loved ones we still have time to protect.
Original Source: https://www.commonhealth.com.tw/blog/6443?utm_source=copyshare&utm_source=copyshare
