Following the decision to raise the National Health Insurance premiums from 4.69 percent to 5.17 percent, the average employee is expected to shoulder an additional NT$63 in monthly premium payment, while Minister of Health and Welfare Chen Shih-chung has promised that NHI premiums will not see further increases in the next two year. Regarding the outcome, National Health Insurance Administration Director General Lee Po-chang in an interview with ETtoday said that the decision was prompted by the law, which requires the NHI to retain a safety reserve equivalent to one months’ expenditures. Director General Lee said that at the previous premium rate of 4.69 percent, the NHI’s safety reserves is likely to dip below the one-month requirement as expenditures have continued to outpace income, leading to the need to raise the premium rate.
Director General Lee said that the NHI has a mechanism linking the system’s revenues to expenditures. While the National Development Council sets the annual expenditure of the NHI each year, the NHI’s revenue streams, including those from the premiums rate 4.69 percent and supplemental premiums, cannot keep pace with expenditures and have led to financial shortfalls. Director General Lee also denied allegations that the NHI losses are the result of mismanagement.
“Even if the premium rate is raised to 5.17 percent, revenues could still fall short of expenditures,” Director General Lee said, despite Minister Chen’s promise that no further premium hikes will be implemented in the next two years.
“We are aware that premiums need to be raised to meet the demands of higher expenditures resulting from an aging population and higher spending on cancers and other diseases,” Director General Lee said, adding that revenues shortfalls have been adding pressure to the NHI system.
From the perspective of the health care system, Director General Lee emphasized that poor morale among medical professionals including physicians, nurses and pharmacists will ultimately harm the interests of the public. Since assuming his post, Director General Lee has strived to improve the working conditions of the health care sector and win the public’s approval of Taiwan’s health care services. “Under this premise, maximizing the value of NHI spending is of paramount importance,” Director General Lee said.
Director General Lee also noted that there are also some issues with the way NHI spending is allocated. He said that while overall expenditures have been rising, spending on drugs, medical consultations and diagnostic testing have been increasing at a disproportionally high rate. “This is among the issues with NHI spending I hope to address through contingency measures,” Director General Lee said.
Regarding medical professionals, Director General Lee said that while compensation is issued through medical points instead cash, when expenditures exceed what is allotted by the global budget, the valuation of individual medical points are eroded and often fall below NT$1 per point. “Imagine how surgeons feel when the compensation for an appendectomy falls from NT$15,000 to NT$12,000 due to erosion of value of medical points,” Director General Lee said, noting that the way to preserve the value of medical points is for the public to refrain from seeking unneeded medical care. That way, medical professionals’ working conditions could be improved by providing them with the same amount of compensation for a reduced workload.
Regarding proposals to raise the cap on copayments for drug prescriptions and diagnostic tests, Director General Lee said that while the public have little qualms about the NT$200 cap on drug prescriptions, even for patients who run up NT$7,000 prescriptions, this situation all add to NHI expenditures. “We are in a bind, as complaints could come from both patients as well as medical professionals,” Director General Lee said, noting that copayment adjustments will take into considerations the opinions of multiple stakeholder groups across society.
Director General Lee said that the lack of copayment requirements on diagnostic tests have led to higher prescriptions for CT and MRI scans and that these expenses have been shouldered by the NHI. The necessity of these tests should be reexamined, Director General Lee said. “If these tests require a modest copayment, physicians will have to explain their necessity to patients, leading to improved dialogue between the two sides, which is not always a bad thing for the health care system.
[2020-1-7/ETtoday]
