A Dolon Institute Report
Cancer has been Taiwan’s leading cause of death for 44 consecutive years, with around 55,000 deaths reported in 2020. Against this backdrop, the Taiwanese government has set an ambitious goal of reducing age-standardised cancer mortality by at least one-third by 2030. Achieving this will require not only continued advances in cancer science and treatment, but also healthcare systems capable of ensuring that innovation reaches patients in a timely and equitable way.
Taiwan Perspectives from the ONWARD Initiative: Advancing Equitable Access and System Readiness in Cancer Care explores the barriers that can prevent advances in oncology from translating into improved patient outcomes. The paper applies the ONWARD framework – Oncology Needs, Workforce, Access, Research & Disparities – to examine how healthcare system and reimbursement challenges can affect access to innovative cancer treatments, using Taiwan alongside examples from other healthcare systems to illustrate the issues.
The report highlights six interconnected barriers across the cancer pathway. These include limitations in diagnostic provision and referral pathways, shortages in the specialist oncology workforce, insufficient data infrastructure, challenges in assessing the clinical benefit of innovative treatments, healthcare affordability and budget constraints, and the increasing complexity of emerging therapies. These challenges are particularly important as oncology becomes increasingly personalised and complex. Access to biomarker testing, for example, is essential for identifying patients who may benefit from precision medicines, yet testing capacity and reimbursement remain inadequate in many healthcare systems. Similarly, new treatment approaches such as CAR T-cell therapies and combination regimens can deliver significant patient benefit while creating new challenges for evidence generation, value assessment, contracting and reimbursement.
The paper also highlights areas where Taiwan is already taking steps towards greater system readiness. For example, Taiwan’s National Health Insurance Administration (NHIA) is using digital and AI-assisted review tools to reduce manual review requirements, improve consistency and potentially accelerate access to innovative cancer treatments. Progress has also been made in aligning reimbursement criteria with NCCN guidelines across lung, breast and colorectal cancers. Importantly, the paper does not argue that healthcare and reimbursement systems need to be completely redesigned. Instead, it calls for greater coordination and alignment between stakeholders to optimise existing systems and frameworks, while maintaining a clear focus on the persistent unmet needs experienced by people living with cancer.
For policymakers, payers, healthcare leaders, life sciences organisations and other oncology stakeholders, the report provides a valuable perspective on the practical barriers standing between innovation and patient access, and the opportunities to address them.
