Former health minister Dr. Yeh Chin-chuan, a prime mover behind the establishment of the NHI, proposed a revised NHI prior to his resignation, and his successor Yang Chih-liang has also called for an upward adjustment of premiums. The latest proposals include a more tiered premium system and a raising of the upper limit of those premiums, meaning the wealthy will shoulder a bit more of the responsibility.

The NHI program is a jewel in Taiwan's crown, earning the praises of many, including Nobel economics laureate Paul Krugman.

The NHI's strengths are its high level of enrollment in the program (99%), the low premiums (4.55% of enrollee's pay, with 30% of the coverage paid for by enrollee contributions), efficient administration (administrative costs account for only 1.7% of expenditure), and its positive impact on the economy (currently healthcare expenses are at only 6.1% of GDP, lower than in more than half of OECD countries).

The NHI provides broad-ranging, convenient treatment options, with no need for long waits for doctors and no limits on which hospitals can be used.

However, the program has found itself facing fears that it may go bankrupt. In the 15 years since its birth, the program has accumulated a NT$55.4 billion deficit, including unpaid debts from local governments around Taiwan. To keep the program solvent, the Bureau of National Health Insurance (BNHI) has been forced to seek substantial loans from banks, with high total interest expenses adding fuel to the financial inferno.

The roots of this crisis are readily found: firstly, in the 15 years since its establishment the number of elderly people covered has ballooned from 1.63 million in 1995 to 2.4 million in 2008. Medical expenses for the elderly are on average 3.3 times that of the general population, and so this increase alone is placing a massive strain on the system.

On top of this, the number of seriously injured or ill people has continued to climb, from only 1.5% of the total population when the program began to 3.1% today, accounting for a total of 27% of NHI claims. An increasing number of different exams and treatments have also become available, including over 600 new drug treatments, costing the program over NT$60 billion.

Another, more political problem for the NHI is the debts owed to it by various local governments around Taiwan.

The major debtor is Taipei City, which is home to a large number of companies and other organizations. Currently enrollees pay 30% of the premiums, employers 60%, and local governments 10%. However Taipei City is the registered home of a large number of companies, not all of whose employees actually reside in the city, but all of whom must be covered by the Taipei City Government regardless. Not wanting to seem like an easy mark, the city government has refused to pay for these people's insurance.

By the end of 2008 the Taipei City Government owed the NHI NT$33.7 billion, 57% of the total debts owed by nine cities and counties across Taiwan. In 2007, the Supreme Administrative Court ruled against the Taipei City Government; however, in order to address the fundamental problem behind the dispute, initially the central government will cover half the contributions of enrollees employed in Taipei City but not registered as residents there, and the administration will bring forward legislative amendments so that the subsidies covering the contributions of disadvantaged enrollees such as low-income households and the disabled, currently paid by local governments, will in future be borne by the central government.

Another cause of the financial hemorrhaging faced by the NHI program is the difficulty in stopping people and hospitals from trying to game the system. For example, the average Taiwanese hospital stay is 10 days, nearly double that of many other countries. To address this, as of 2010 the Bureau will institute a diagnosis-related group prospective payment system (DRG-PPS) in an attempt to reduce the length of hospital stays and the amount of unnecessary surgery, prescriptions, and examinations. They will also implement a plan under which elderly patients with several complaints will be able to get full treatment from a single doctor rather than bouncing around the hospital, thus reducing the fee burden on elderly patients and saving medical resources.

After taking office in August, Yang Chih-liang announced a future increase in premiums, ideally to around 5.13%, in an effort to avoid the program going bankrupt. The vocal response to this, particularly from employers, has led to the plan being scaled back, now aiming to increase the number of income bands against which contributions are assessed, and to raise the ceiling of the top income band to include earnings up to around NT$200,000. This will affect some 80,000 people and result in the injection of an extra NT$1.3 billion into the NHI's coffers per year. However there are concerns that this will only affect those whose pay is consistently this high, while people like celebrities, who receive large sums on an irregular basis, and CEOs, who often receive multi-million-dollar year-end bonuses, will be able to sidestep these new regulations.

In response, early in 2008 the BNHI put forward legislative amendments that would take into account total annual income-either individual or household-but sadly these changes are still languishing in the legislature. Currently, Minister Yang is pushing hard for the changes to be enacted as soon as possible in order to "save the NHI's finances." Through these measures, it is hoped that the NHI can look forward to finally breaking even while also upholding principles of social equality.