Corporate Social Responsibility and Social Needs in Health-Care Sectors – A Critical Analysis of Social Innovation in The Health Sector in Taiwan

Social innovation, as the OECD defines, is “the design and implementation of new solutions that imply conceptual, process, product, or organizational change, which ultimately aim to improve the welfare and wellbeing of individuals and communities” [1]. Innovation also takes the form from establishing of social businesses to corporate innovations. Innovation has shifted from a project-based approach towards a results-based agenda, which centers around achieving and measuring specific results. When a social business is seeking funding, donors or investors examine their theory of change and business models closely before granting a loan or other forms of funding. Hence, the results-based agenda clearly applies. However, corporations may be detached from this framework, as larger firms are financially sustainable and are less reliant on outside investments. As a result, the resultant yet critical question is whether corporate innovation brings changes that address social needs while being sustainable. This paper analyzes some corporate social responsibility (CSR) programs in Taiwan, focusing on the health sector, to answer what CSR looks like in a developed context and whether it achieves the intended goals and results.

Today’s CSR programs have their roots in corporate philanthropy when wealthy businessman and philanthropist Andrew Carnegie challenged wealthy people to support social causes. CSR, however, only truly began to take hold in the United States, in the 1970s, when the concept of the “social contract” between businesses and society was outlined. Various organizations worldwide now engage in CSR programs to show their corporate commitments and responsibilities toward sustainable development. CSR have evolved from a nice thing to do, to a necessity for a successful business. In today’s innovation-led society, organizations can no longer afford to merely involve in charity, but to move beyond CSR to corporate social innovation [2]. 

Though originating from generating social impact, CSR, received criticisms such as promoting greenwashing [3]. Corporations may be reluctant to shift its focus from profit-making and shareholders may not want to adopt CSR programs. A study from Taiwan indicates that given Asian’s firm culture, firms that are collectively owned or government-owned are more likely to take serious efforts to integrate CSR into aspects of their business operations while firms that are still expanding and family firms are less likely to devote efforts into CSR activities since the firms’ financial performance have more importance. At the same time, the study also highlights that firms that devote efforts into CSR are more likely to earn higher earnings and gain better reputation, which can reduce business risks. This narrative then fits into the speculation that for firms to receive higher earnings, they may engage in greenwashing, under the name of CSR [4].

Although CSR has been a widely known concept in business institutions, there are limited literatures about CSR in the health sector. CSR in health can be introduced from inside and outside the health sector. Corporations outside of the health sector can contribute to a better health system or engage in health promotion activities.

Pharmaceutical companies or health care providers can also go beyond their profit objective. As the world has been menacing over the stubborn COVID-19 pandemic coupled with a high time for strengthening health systems, it is hard to disagree with the statement that healthcare activities have emerged as the most crucial CSR activity in current times [5]. 

CSR for the health sector can take place in many forms, examples of some activities that can be executed include, but are not limited to [6]: 

• Develop community partnerships for health promotion and equitable access to health
• Provide financial and technical support to advance medical technology and contribute to cutting-edge medical research
• Integrate equitable health care delivery through inter-sectoral partnerships
• Manufacture and sell drugs at a lower price for economically vulnerable population
• Protect environment health through the usage of green energy sources to supply power for medical institutions and mange wastes with respect to the environment
• Monitor product supply sourcing of the whole supply chain to guarantee procurement of materials and equipment from pharmaceutical firms known for the quality of their products that respect the environment, labor law, and human rights.
• Support fundraising for rare diseases 

The locations corporations choose to implement CSR activities can be different from the firm’s location. Social innovations in health have brought notable progress in addressing barriers associated with access and cost of care in both low- and middle-income countries. The focuses in low- and middle-income countries include improving access to reproductive health care, nutrition, health infrastructure development, and sanitation projects [7]. Although there are more nuances in ways to contribute to health CSR activities in developed countries, there are still gaps that corporations’ CSR activities can focus on. This paper uses Taiwan as a case study to explore social innovations in Taiwan and how corporations have implemented CSR activities in the health sector, given that Taiwan already has a great national health insurance system and will be expecting the fastest economic growth since a decade [8].

Social innovations in Taiwan 

Renowned for its export-oriented technologically intensive economy, Taiwan also has a long tradition of charitable religious giving. The tradition of charitable religious giving alone created a favorable ecosystem for social innovations to thrive. As a result, social innovations have been blooming in Taiwan over the past two decades. However, an analysis raised the question of the sustainability of social businesses in Taiwan, as the government and charity giving provide quite a generous funding for social enterprises. In 2018 alone, 12 different branches of the government provided over 88 billion Taiwanese dollars over a 5-year period. The high amount of funding may create dependency on governmental support, rather than seeking other external investors or develop their business model [9]. 

As for corporations, similarly to other countries, CSR developed as part of corporations’ efforts to engage in social innovation and social responsibility in addition to its profit-driven activities. Current establishments of CSR tend to focus on the rights of employees, shareholders, environment and sustainability community development and supply chain relationship. However, there are gaps in implementation and reporting of CSR. A survey of Pricewaterhouse Coopers indicates that only 9% of firms in Taiwan include SDGs in the CSR reporting compared to 71% of the firms globally. This huge gap in SDG reporting then circles back to the main themes of the paper. What are the CSR initiatives in health in Taiwan? What are some social innovations in the health sector? Could the lack of mention of SDGs in CSR reporting overlook CSR initiatives in the health sector? 

Mapping of Taiwan’s health care system 

Taiwan prides itself with its accessible, low overall cost of health care and universal health care coverage. In fact, due to the advancement in ICT industry, Taiwan ranks 13^th in the World Index of Healthcare Innovation, according to research from The Foundation for Research on Equal Opportunity [10]. In the last 1980s, the Taiwanese government then recruited several U.S health economists for health policy reforms. The group recommended a single-payer model, in which the government was the sole provider of the health insurance, and the financing was modeled on the German system, in which premiums are deducted through individual payroll taxes. Building on the principles of equity in access and benefits, effective and egalitarian cost control, and administrative simplicity to help the public understand the system [11], the national health insurance system (NHI) was implemented in 1995. The NHI benefit package is more comprehensive than any typical Western single-payer system. The coverage not only includes inpatient and outpatient care (preventative, primary, and specialist care), but also includes dental care, mental health care, physical rehabilitation, home nursing and traditional Chinese medicine. Enrollment in NHI is mandatory for all citizens and foreigners legally residing in Taiwan for longer than six months. Virtually all residents are enrolled. 

In 2009, Taiwan further introduced a universal system of electronic health ID cards, which resembles chip-based credit cards that store patients’ demographic and health information, including past medical visits and histories, claims data and prescription file. Health care services can only be provided if a health care professional and a patient simultaneously use their cards to confirm a transaction. Each individual health facility can also use the card to check for past visitations and prescription history at other health facilities to streamline health care provision to the public and health care administration for the professionals. This system gives Taiwan real-time claims data, enabling the government to identify areas of increased utilization, which notably helped Taiwan prevent the initial outbreak of COVID-19 [12]. 

Healthcare is an important factor in poverty alleviation. With a national system that is efficient, currently, Taiwan’s public health spending accounts for fewer than 6% of its GDP. However, the healthcare system is not without flaws. For instance, copayments for outpatient prescription drugs covered under NHI are capped at TWD 200 (USD 6.6) per outpatient visit, regardless of how many drugs are prescribed during that visit and there is no annual cap on drug copayments [13]. While the low cost of care is attractive at first glance, the caveats to this single-payer and low-cost universal coverage can result in over-reliance on hospital care and over prescription. 

There is also a gap in urban-rural health care utilization. Despite implementation of NHI covered up to 99% of the population, there is an urban-rural disparity in preventative health care utilization. Studies have suggested that even with NHI, health intervention efforts, such as preventive medicine, might not have effectively reached more rural residents of Taiwan. As a matter of fact, there is a phenomenon of “coverage without access” among the Taiwanese aboriginal population, mostly residing in mountainous townships and experiencing lower socioeconomic status, and exhibiting poorer social determinants of health. They also have limited access to adequate high-quality health care services [14,15]. 

Existing CSR projects in health 

In Taiwan, CSR are still dominated by large-scale companies in the financial sector, and science and technology industries. Few medical industries and hospitals have published their social sustainability reports. While there are some studies on the lack of CSR performance of medical institutions in Taiwan, among the publicly released social responsibility sustainability reports of the hospitals, the contents mainly focus on the current situation of the hospital, management, friendly workplace, and medical services [16]. Even though CSR intend to create positive social impact, findings also point out that CSR of hospitals have different “quality”. In general, hospitals operated by private universities do poorly in CSR, which is an apparent result of the current laws that do not ask them to abide by rules of statutory public welfare expenditures, whereas medical research centers have more tendency to compile reports on CSR [17]. CSR projects in health are either implemented by hospitals as part of their efforts towards contributing towards environmental sustainability or implemented by other industries to advance the developments in health. These CSR projects in the health sector in Taiwan stood out as following: 

1. Advancing medical technology: AUO, a company that specializes in optoelectronics, partnered with ADLINK Technology, the global leader in industrial computers, to introduce 20 medical panel computers with high-resolution, anti-glare and touch-screen medical display technology to National Taiwan University Hospital to enhance the infection prevention and control needs during the pandemic. Usage of these high-tech displays is expected to safeguard the health of medical personnel in Taiwan, upgrade the efficiency and accelerate the digital transformation of the medical industry [18]. 

2. Integrative approaches for a greener environment: Missioncare, a health care provider and institution, not only adheres to practices that are outlined under good environmental sustainability practices, but also values the rights and potential of its employees. Missioncare offers a scholarship for the employees that attend part-time executive programs and offers free yearly physical examples for all its employees [19]. 

3. Donate PPE for those in need: Medtecs, a leading personal protective equipment (PPE) supplier, donated surgical masks, gloves, and many types of PPE gears during the COVID-19 pandemic to NGOs in Taiwan and some organizations abroad for emergency support. However, Medtecs only incorporated CSR since February of 2020 and some donation recipients seem to be driven by external factors like diplomatic ties [20]. 

4. Well-rounded CSR that incorporates different dimensions of health improvement: Acer, a Taiwanese multinational hardware and electronics corporation, has been incorporating CSR to advance social development and sustainable development. However, during the pandemic, they increased a category of CSR under “COVID-19 response”. The newly added activities include employee blood drive for the community, collaboration with the National Defense Medical Center to use AI technologies for accelerated vaccine development, collaboration with the Taiwan Centers for Disease Control to establish “THAS” surveillance system for infection and antimicrobial resistance that helps hospital administrators understand the status of infection and antibiotic resistance in their hospitals. This innovation was awarded the Global ICT Excellence Award – COVID-19 Best Industrial Solution [21]. 

5. Leverage community partnerships to elevate wellness of the elderly: Pfizer Inc, the American multinational pharmaceutical and biotechnology corporation that developed a COVID-19 vaccine has a branch in Taiwan. In face of population aging, since 2012, Pfizer Taiwan partnered with local NGOs to form volunteer groups to keep senior citizens who live on their own, in remote areas company during the holiday seasons and took them for holiday shopping [22]. 

6. Health promotion and nutrient consumption matters: Taiyen Biotech, a salt manufacturer that transformed to a customer-oriented service industry that safeguards public health and beauty with premium biotech products. In its 60-year history, the company has devoted its efforts to public health promotion on consumption of sodium and potassium [23]. 

7. Creating a healthy and happy tomorrow through medicine and nutritional care: Taiwan Millennium Health Foundation, a foundation created as part of the CSR initiatives of Uni-President, the largest food production company in Taiwan and Asia, aim to promote healthy lifestyles and medical knowledge through health campaigns and its “National Health Day” to screen for metabolic diseases in Taiwan. Together with 7-eleven, the leading convenience store in Taiwan, they supply blood pressure monitors, waistline tape measures, and pamphlets for health education to raise awareness of metabolic diseases and the benefits of maintaining a healthy lifestyle [24].

The projects above are initiatives of multinational companies, health care providers, or local Taiwanese firms and these projects encompass a great variability of what CSR in health could be. While some larger firms in Taiwan have been incorporating CSR since the early 2000s, many CSR projects only started under the wider mission of creating a better environment and improved employee well-being after the Company Act came into force under the Ministry of Economic Affairs in 2018. This act writes: “when conducting its business, every company shall comply with the laws and regulations as well as business ethics and may take actions which will promote public interests in order to fulfill its social responsibilities” [25]. A number of health projects only emerged during the COVID-19 pandemic through mechanisms of in-country donations and “PPE-diplomacy” to Taiwan’s allies in Southeast Asia (i.e. Medtecs). These approaches have good intentions but will most likely only generate a one-time only or short-term effect, which contradicts the purposes of social innovation for sustainable change. 

To promote innovations in the private sector, the government awards the best CSR programs. Since Taiwan is an export-oriented economy and CSR is now increasingly used as part of company branding and strategy to gain momentum for international collaborations, many companies are forced to engage in CSR activities or else they risk losing contracts. Substantial evidence also suggests that CSR and financial earnings are intertwined, corporations are self-serving and only engage CSR when it yields benefits. Typically, charitable giving attracts the publics’ attention, so the media only writes about big fundraisers and donations while CSR programs on community engagement and sustainability do not grab interest of the public. This resulting external pressure, in turn, affects how corporations engage in CSR. While the CSR projects in the health sector illustrated above show how diverse CSR programs can be, it also reflects the trends of public interest. Donations for medical devices have always existed and PPE donations gained momentum during the COVID-19 pandemic, yet none of these CSR programs address the need in closing the urban-rural health utilization among Taiwanese indigenous communities.

With gaps to fill, CSR is only at the margins in Taiwan. Just like boosting social innovation, effective and sustainable CSR requires talent and cross-sector collaboration to reach the full potential. Current CSR activities in Taiwan are driven by awards, public relations interest, and other external interests. As the type of CSR activities in Taiwan that attract media attention are philanthropic activities, it is also suspected that CSR positions in corporations will not require much technical expertise on sustainable development. A review of several recruiting announcements for CSR positions on 104.com, a popular job board in Taiwan, confirmed these speculations. With the exceptions of companies already working in the environmental or biomedical field that specifically require their CSR personnel to have relevant knowledge and experience in sustainable development, climate change and/or carbon reduction, CSR positions in other firms do not have a targeted profile and are generally positioned under the offices of public relations, administration, or donor relations.

Positioning CSR under offices of donor relations or public relations will eventually cause CSR strategies to deviate from its intended impact. To make the whole CSR system work, management need to take a participatory approach to enable a business ecosystem that is ready to create changes. For the corporations reviewed in this paper, a good example of participatory management can be seen in the organizational model of Taiwan Millennium Health Foundation, which appointed public health and medical professionals as their board of directors to shape their strategies. To fulfill the unmet needs and achieve lasting impact, corporations should be ready to either develop partnerships with public health experts in academia and civil society to address the gap in urban-rural health care utilization or employ a CSR personnel with health background who is able to navigate the playing field between health, business, and policies to develop CSR strategies.

Social innovation is a multi-dimensional concept used to jump start government transformation, public-private collaborations, and the broader social systems to address social needs that cannot be reached by the public or private sector alone. The process of social innovation also fosters greater inter-disciplinarity and inter-sectionality that leads to new forms of power relations and empowerment. There is more work to be done to change the ecosystem for innovation. As progress in health care is key to poverty reduction, but despite being categorized as a developed context, there is still room for improvement in CSR programs to address health needs in Taiwan. CSR in Taiwan promotes SDG washing. In the eyes of the experts, CSR are supposed to be innovations or new measures that contribute to creating a better Taiwan or making progress on specific SDG indicators, not about tweaking annual reports to align its existing statements with SDG indicators. Additionally, big corporations are supposed to engage in innovations for social impact, but the criticisms of CSR greenwashing and SDG washing exist as corporations often face pressure to engage in philanthropic activities for media interests. Engaging in these activities will only undermine the importance of CSR and SDGs in the long run, change is needed to align CSR back with its initial goals. CSR strategies also often come from a top-down approach, and firms in Taiwan have strong hierarchical culture so it could be hard to change existing strategies. However, corporations in Taiwan have the potential to undergo transformation.

As more and more young generation now have heard of sustainability, circular economy, CSR, and SDGs in Taiwan; and management and business schools are also incorporating training including sustainable supply chain management in their curriculum, there is potential of transforming the way corporations in Taiwan run in the future. It is envisioned that the next generation of business leaders will balance the needs of business, human rights, and sustainable development in their management, while engaging the interests of citizens and stakeholders in the public and private sector for sustainability and social change.

1. All authors of the manuscript have read and agreed to its content and are accountable for all aspects of the accuracy and integrity of the manuscript;
2. This manuscript is original work that is not being considered or reviewed by any other publication and has not been published elsewhere in the same or a similar form.

1. https://www.oecd.org/regional/leed/social-innovation.htm
2. Jali M, Abas Z, Ariffin A (2017) Corporate Social Responsibility and Corporate Social Innovation: A Conceptual Understanding. SHS Web of Conferences 34.
3. https://medium.com/@catchfoundationngo/advantages-and-disadvantages-of-corporate-social-responsibility-csr-e0fb217a0e13
4. Wu S, Lin F, Wu C (2017) A Study on Taiwanese Corporate Social Responsibility, and Ownership Structures. Corporate Ownership & Control 9: 3.
5. https://www.vantagefit.io/blog/corporate-social-responsibility-in-healthcare/
6. https://www.publichealthnotes.com/corporate-social-responsibility-csr-health/
7. Van Niekerk L, Manderson L, Balabanova D (2021) The application of social innovation in healthcare: a scoping review. Infect Dis Poverty 10: 26.
8. Chan E (2021) Taiwan expects fastest growth in a decade this year on export boom. Reuters
9. https://www.seinsights.asia/article/7111
10. https://freopp.org/taiwan-13-in-the-2022-world-index-of-healthcare-innovation-8d99f37084db#:~:text=Taiwan%20also%20placed%2013th%20in,overall%20cost%20of%20health%20care.
11. https://www.commonwealthfund.org/international-health-policy-center/countries/taiwan
12. https://freopp.org/taiwan-freopp-world-index-of-healthcare-innovation-69c3b3b17a46
13. https://www.commonwealthfund.org/international-health-policy-center/countries/taiwan#:~:text=Taiwan's%20national%20health%20insurance%20(NHI,%2C%20civil%20servants%2C%20and%20others.
14. Wang F, Weng H (2020) Mapping Regional Well-Being in the Universal Health Coverage System in Taiwan. Risk Management Healthcare Policy 8: 13.
15. Lee YT, Lee YH, Kaplan WA (2019) Is Taiwan’s National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships. International Journal of Health Planning and Management 34: 1.
16. Chen LC (2020) Corporate Social Responsibility and Sustainability Reports of Medical Industries and Hospitals in Taiwan. Taipei City Medical Journal 17: 1.
17. Hsu CC (2020) Fairly presenting the CSR performance of various types of medical institutions in Taiwan. NTU Graduate Institute of Health Policy and Management Master-level Dissertation.
18. https://csr.auo.com/en/news/news/32f2eefb-52ba-44f3-8be6-2ee572b5352b
19. https://www.missioncareasia.com/web/csr.html
20. https://www.medtecs.com/zh/sustainability/
21. Covid-19 Pandemic Response”. Acer Group.
22. Pfizer.
23. https://www.tybio.com.tw/taiyen/tw/csr/view/4/51/6
24. https://csrpro.irpro.co/upload/20210923162018-1.pdf
25. The Company Act. Laws & Regulations Database of the Republic of china.