National Health Insurance (NHI) finances has ended in the red for three consecutive years, with the shortfall set to reach a record high NT$67 billion this year. Although the gap can be filled by the NHI’s safety reserves, the safety reserve could dip below the legally required threshold equivalent to 1.5 months of NHI’s medical expenses by the end of 2021 at the latest, which will trigger premium adjustments required by law. The focus of the National Health Insurance Committee (NHIC) this November will be focused on negotiating a rate increase for review by the Executive Yuan.
Ahead of the finalization of NHI premium adjustment, civic groups have continued to voice their appeals. Dr. Yaung Chih-liang, a former health minister and chairman of the Taiwan Alliance of Patients’ Organizations held a joint press conference with the Hope Foundation for Cancer Care (HFCC) and the Formosa Cancer Foundation (FCF). The HFCC called for the NHIC to not only adjust the premium but to also change the current copayment system to a fixed rate system as stipulated by the enabling statute governing the NHI, and to ensure that the NHI is able to balance its income and expenditure, as well as formulating measures to protect disadvantaged groups.
Dr. Yaung said that cancer is the number one cause of death Taiwan and that a significant portion of the population will become cancer patients. However, as the population ages, there will be more elderly patients who need a tremendous amount of medical resources while the number of healthier, younger people who are the primary contributors of NHI premiums will only get smaller. If the trend continues, the NHI system will become unsustainable.
Chairman Yaung estimates that the next premium adjustment will need to be implemented in 2021 and that the premium rate needs to be increased from the current 4.69 percent to more than 5.4 percent. After that, the increment of each premium increase will need to be at least 10 percent. At that pace, premiums will quickly reach the legal cap of 6 percent, when no further increases can be made. When that day comes, whether Taiwan could make the required law amendments to raise the premium to above 6 percent is uncertain.
HFCC Chairman Wang Cheng-hsu pointed out that according to a survey of more than 1,000 members of the public conducted by the foundation, more than 60 percent of respondents said that they are willing to pay an extra NT$100 in premiums each month to maintain the sustainability of the NHI, indicating that there is some head room to adjust the premiums. While the law stipulates a fixed rate copayment of 20 percent of medical expenses, in practice, patients only pay a copayment of 6 percent, far below what is legally required.
Therefore, the HFCC advocates a return to the fixed rate system in accordance with the law, while setting the upper limit of each outpatient’s copayment at NT$2,000 and a NT$65,000 cap on inpatient care copayments per annum, along with separate caps for disadvantaged groups.
FCF Deputy Chief Executive Tsai Li-juan said that a person is diagnosed with cancer every 4 minutes and 42 seconds, yet the median time for a new cancer drug reimbursement application to be approved can take up to 18.7 months. Despite the urgent need for cancer treatments, patients often must wait three to five years for new cancer drugs. Additionally, although 72 percent of reimbursement applications for new cancer drugs are approved, there remains many restrictions, such as limits on the number of treatment cycles and stipulations that certain drugs are only reimbursed for late-stage cancer patients.
Deputy Chief Executive Tsai pointed out that even if the new drugs are included for reimbursement, many patients will not be eligible. Due to financial considerations, cancer treatment in Taiwan is falling behind international guidelines. This has led to far reaching impacts, with patients having no chance to participate in clinical trials. She also urged that the NHI should not be trapped in its reimbursement-centric thinking and should consider the value of new drugs from the patient’s perspective. The neglected value of new drugs include shorter hospital stays, lower frequency of outpatient emergency care, maintaining the ability to work, go to school and the ability to maintain an independent lifestyle, improved quality of life, which are all very valuable factors for patients.
The FCF voiced slightly different appeals than that of the HFCC. FCF Deputy Chief Executive Tsai pointed out that according to the foundation’s survey of 909 cancer patients, 72 percent of respondents said that they are willing an extra NT$5,000 per month for improved access to new drugs, while 67 percent are willing to pay an extra NT $20,000 per month, with more than 17 percent willing to pay an NT$100,000 per month, which could be indicative of a way forward in balancing the need to address NHI finances and ensuring patients’ interests.
[2020-11-05/United Daily News]
