The National Health Insurance’s (NHI) finances have ended in the red during the past four consecutive years, and the shortfall has expanded to NT$67.1 billion. In order to achieve solvency, NHI premiums will be raised next year. The final rate increase has not yet been finalized, pending a final decision by the Executive Yuan. However, the current proposed rate increases are only expected to keep the NHI solvent in the next two years at most. Minster of Health and Welfare Chen Shih-chung at a public hearing on bolstering NHI finances said that the health ministry has been asked to propose separate medium-term and long-term reform plans to achieve the expansion of NHI income while also cutting the system’s expenditure.
Minister Chen said that there are pros and cons to the NHI’s design. Following the establishment of the global budget mechanism in 2003, reviewing and controlling the system have become necessary. The global budget mechanism makes it impossible to increase the NHI’s administrative funding, which limits the ability for the system to improve despite officials’ desire to do so. Minister Chen believes that the NHI as a social insurance system must be “hardened” and that there should be other ways apart from adjusting premium rates to ensure the system’s sustainability.
Department Social Insurance Director Shang Dong-fu said that the mid-to long-term NHI reform plan is roughly divided into three parts. One is to reform the NHI reimbursement scheme, such as the approval process for new drugs and an exit mechanism for drugs. Despite the limited resources afforded by the global budget, it is nearly impossible for a drug to be removed from the reimbursement scheme. Therefore, a “fair and just” review and reevaluation mechanism must be formulated.
Regarding the much-maligned provision of reimbursements for instruction drugs and opinions calling for their removal from the reimbursement scheme, Director Shang indicated that in the past 25 years, the withdrawal of 1,500 instruction drugs from the reimbursement scheme have been completed, leaving around 800 to be withdrawn. According to the National Health Insurance Administration (NHIA), it is up to specialist physicians and the NHIA to submit proposals to remove drugs from the reimbursement scheme.
Secondly, Director Shang said that the integration of the resources of the public health system and the NHI are part of efforts to promote investments into better health. These efforts include the recent initiative to eradicate HCV. While the initiative could cost around NT$50 billion each year, it is expected to lower expenditure on liver diseases in the long run. Director Shang also said that following HCV, similar initiatives to cut the occurrence of other major diseases such as cancer through screening are being planned by the Health Promotion Administration but they have yet to be finalized, nor has the National Health Insurance Committee gave its nod to fund lung cancer treatment for cases identified by screening.
Thirdly, the health care system must be reformed to improve inpatient care and long-term care, strengthen the capabilities of community care systems along with the implementation of smart health care technologies. Other areas that need reforming include changes to the way the performance of health care workers are evaluated and improving the quality of services provided at hospitals.
Director Shang said that the mid-to-long-term NHI reform is expected to start in 2021 and that authorities will actively explore ways to bolster the NHI’s financial condition after NHI premiums are adjusted.
[2020-12-04/United Daily News]
