Reports of plans to increase National Health Insurance (NHI) premiums next year have given rise to NHI reform issues once again. Driven by an aging population and advancements in medical technology, Taiwan’s National Health Insurance global budget has continued to grow each year. The 2013 NHI global budget was around NT$553.1 billion and the figure has since grown to exceed NT$750 billion. While the global budget has continue growing to ensure provision of health care, concerns about the system’s sustainability have returned to the spotlight again.
The amount of medical points has also been growing steadily each year, although at a slower pace than that of the global budget. In 2013, the NHI total budget was about NT$553.1 billion, during which around 589.2 billion medical points were awarded. By 2019, 773.1 billion medical points were awarded, with the global budget of the same year set at NT$715.3 billion. In 2020 the global budget grew and exceeded NT$750 billion.
As the value of a medical point is not always equal to NT$1 and is calculated based on the necessity and reasonability of claims filed by medical service providers, the value of medical points in recent years have fallen below NT$1, leading to disgruntlement among medical professionals.
According to statistics from the Ministry of Health and Welfare, the total number of medical points awarded and the global budget have both shown continued year-on-year growths. In 2013, medical points and the global budget were 589.2 billion and NT$553.1 billion respectively. However when the amount of medical points rose to 661.8 billion in 2016, the global budget during the same year had only just exceeded the NT$600 billion mark to NT$619.6 billion.
In 2017, the amount of medical points set a new high record at 700.8 billion points, compared to the global budget of NT$654.5 billion during the same period. It wasn’t until 2019 when the total number of medical points reached 773.1 billion did the global budget keep pace with growth and rose to NT$715.3 billion.
As NHI expenditures continue to grow, the total NHI budget for 2020 set another new high record at NT$752.6 billion, but the total number of medical points reached 575.5 billion points from January to September. As the NHI total budget continues to swell without premiums adjustments, it is expected that the NHI’s shortfall will reach NT$67.6 billion at the end of 2020 and NT$77.1 billion in 2021.
Regarding the ever-growing NHI expenditures, stakeholder groups have argued over possible causes, including the aging population and wastage of medical resources. Former Health Minister Yaung Chih-liang attributed the NHI’s runaway costs to advancements in new drugs and new medical technologies, saying that an aging population is not the main factor.
National Taiwan University College of Public Health Dean Cheng Shou-hsia said that constraints of the global budget and a lack of trust between medical institutions who are each vying to treat more patients, have led to devaluation of medical points. To address issues with the valuation of medical points, the reimbursement system must be reformed.
Dean Cheng said that the remedy is to not use the current fee-for-service model and adopt alternatives such as capitation, pay for performance or case-based payment, but each of these come with their own difficulties and will lead to significant disruption to established operating models of medical institutions.
Dean Cheng said that the elderly population will continue to grow and lead to declining productivity, meaning that more investments will be required to achieve the same level of health care services capacity. If and when the NHI premium rate is adjusted to a certain level, people should start to discuss how to overhaul the reimbursement system, but that is likely to be a feat much more difficult to achieve, in particular as there are also political factors to consider, Dean Cheng said.
Regarding the gap between the global budget and medical points allotted, National Health Insurance Administration Director General Lee Po-chang said that since the global budget is fixed, the value of medical points will be devalued as more claims are made for medical services rendered. The situation has not been helpful towards morale among medical professionals, who may feel like they are not given reasonable compensation for their work.
Regarding the pressure for NHI financial reform, Director General Lee bluntly said that the NHI expenditures have continued growing each year at a rate between 4 percent to 5 percent, with some attributing it an aging population and advancements in medical technology, which has led to dwindling NHI safety reserves and continued annual fiscal shortfalls.
Director General Lee said that although this is why the government is considering adjusting the NHI premium rate, the fact is that any expansion to the health care ecosystem will cause higher expenditure. NHI expenditure is growing every year, but if everyone thinks that the NHI rate cannot be increased or expanded, there will always be a gap between the global budget and the amount of medical points awarded.
[2020-12-20 / United Daily News]
