Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to (...) evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity. (shrink)

After characterizing Taylor’s general approach to the problems of solidarity, we distinguish and reconstruct three contexts of solidarity in which this approach is developed: the civic, the socio-economic, and the moral. We argue that Taylor’s distinctive move in each of these contexts of solidarity is to claim that the relationship at stake poses normatively justified demands, which are motivationally demanding, but insufficiently motivating on their own. On Taylor’s conception, we need some understanding of extra motivational sources which explain why people (...) do (or would) live up to the exacting demands. Taylor accepts that our self-understanding as members of either particular communities or humanity at large has some motivational power, but he suspects that in many cases the memberships are too thin to resonate deeply and enduringly within us. In Taylor’s view, a realistic picture of what moves people to solidarity has to account for the extra motivation, when it happens. We propose an alternative view in which morality, democracy and socio-economic cooperation can be seen as separate spheres or relations which are normatively justified, motivationally demanding, but also sufficiently motivating on their own. (shrink)

Under the influence of concerns about sustainability, health system reforms have targeted institutional designs and have overlooked the role of socio-political factors like solidarity—a concept that is generally assumed to underpin the redistributive health system. The purpose of this research is to investigate users’ perceptions of the National Health Insurance as a system, their senses of solidarity and their views on the sustainability of the system in Taiwan. Using the descriptive ethics approach, qualitative in-depth interviews were conducted with typical case (...) sampling of 17 participants in the Taipei Metropolitan. The framework approach was used to analyze the interview transcripts. The research finds that despite great differences between users’ perceptions of the NHI, most users could share a notion of mutual relationship among each other. Three types of reasons are used to justify the obligations of mutual aid imposed by the NHI. These reasons are embedded within divergent conceptions of solidarity. The research also finds that government’s performance, the stability of decision-making and users’ personal experiences engaging with the system are important conditions for the users’ supportive attitude toward the system. Solidarity is a plausible concept in sustaining a non-Western social health insurance such as Taiwan’s NHI. (shrink)