In recent years, resources to fund new treatment options for patients with urgent needs has become the prevailing topic of discussion. Despite a slight increase in the budget for new medical technologies, access to new drugs remain limited due to the finite resources of the National Health Insurance Administration. A recent survey found that 80 percent of respondents are willing make out of pocket payments for new drugs. A separate survey by a patient group also found that respondents are willing to contribute copayments to have a chance at gaining earlier access to new drugs. At the same time, patients are hoping for the government to come up with measures to expand National Health Insurance (NHI) income streams and to adjust the allocation of resources to improve patient access to new drugs.
The National Health Insurance Committee (NHIC) on September 24-25 held meetings to discuss the 2021 NHI global budget. NHI global budget items that were unable to reach a consensus among the NHIC will deferred to Minister of Health and Welfare (MOHW) Chen Shih-chung for approval. Although the 2021 budget for the new medical technologies is projected to reach NT$3.562 billion, the highest in recent years, the amount falls short of what is needed to meet patients’ needs. In light of the system’s strained finances, the NHI has little option but to tighten reimbursements, which lead to severe challenges to patients with lower incomes who cannot afford the new drugs that they need.
A patient who wishes to be identified as M.S. Hsiao, a mother of two, was diagnosed with advanced lung adenocarcinoma in early 2019. Since her diagnosis, M.S. Hsiao was treated with drugs, followed by surgery. However, M.S. Hsiao’s cancer recurred in November. Her husband said that due to concerns about the family’s ability to bear medical expenses, M.S. Hsiao had refused to undergo treatment with targeted therapy drugs and insteadopted for Chinese medicine to ease her symptoms. Consequently, M.S. Hsiao’s condition worsened as the size of her tumor continued to enlarge. It was not until a follow up consultation where M.S. Hsiao saw a glimmer of light when she learned that a new lung cancer drug is covered by NHI reimbursement.
The anecdote above is not an outlier but a common challenge faced by many patients. In many cases, patients often find that it takes more than five years for the new drugs they need to progress from marketing approval to gaining inclusion under NHI reimbursement. Former health minister and chairman of the Taiwan Alliance of Patients’ Organizations Yaung Chih-liang said that strengthening NHI finances is a major factor in the drive to accelerate the introduction of new drugs and technologies to Taiwan and gaining approval for NHI reimbursement, The pervading approaches are to raise NHI premiums and to raise contribution from copayments, such as lifting the NT$200 cap on medical consultation and drug prescriptions as well as canceling reimbursement for instruction drugs, such as those for stomach and common cold symptoms to ensure that the NHI is able to balance the need to maintain its sustainability and improving access to new drugs.
According to the latest poll released by the Hope Foundation for Cancer Care released October 8, more than 60 percent of respondents are willing to pay and additional NT $100 in insurance premiums per month, with 60 percent willing to contribute higher payments for outpatient consultations, medical exams and drug prescriptions. A separate survey released April showed that about 80 percent of respondents are willing to shoulder out of pocket expenses. In particular, the survey found that younger respondents with higher education between the ages of 20 and 39 showed higher willingness to shoulder larger contributions to the NHI. Additionally, findings show that the majority of respondents who are willing to make larger contributions to the NHI are middle aged who are already shouldering considerable financial responsibilities. If diagnosed with severe diseases that require considerable out of pocket expenses, these people often must face the difficult choice between treatment and providing for their families. As a result, those who lack the financial capacity to fund treatments are facing tremendous challenges. A 2019 survey by the Formosa Cancer Foundation showed that 70 percent of cancer patients support higher copayments of up to NT$5,000 per month, with 20 percent willing to pay more than NT$100,000 per month. The outcome show that many are willing to pay more to improve the accessibility to new drugs and technologies.
With the NHIC set to finalize its plans to address ailing NHI finances, Chairman Yaung believes that in order to preserve the NHI’s sustainability and to allow the system to continue to protect the public’s health, the NHI system must be adjusted continuously to ensure the people’s right to access health care services. The NHI should be assessed continuously to ensure that resources are distributed to those in need.
[2020-11-9/Storm Media]
