The finances of the National Health Insurance system are structured around   a global budget where reimbursement for medical consultation and treatments is provided in form of medical points. However, when health care providers overprescribe treatments and drugs to the point where the amount of medical points due exceeds that of the global budget, the value of each medical point decreases, leading to reduced cash compensation for medical professionals. Management of communications between the public and medical professionals must be improved to address the issue collectively and ensure the sustainability of the health care system.

While academic and medical circles have long debated over whether Taiwan’s NHI counts as a form of social welfare or insurance, often, people with no medical needs feel that the monthly NHI premiums and supplementary premiums are an expensive burden and only realize the value of the NHI when they or their loved ones become seriously injured or ill.

From 2018 to 2020, the National Health Insurance Administration (NHIA) with the assistance of experts included 55 new cancer drugs for reimbursement, covering 16 types of cancer with an annual drug expenditure of NT$12.8 billion, benefiting an estimated 8,000 patients. Regarding rare diseases, 20 drugs were included, leading to annual drug expenditure of about NT$1.6 billion, benefiting more than 1,000 patients. For HBV, annual drug expenditure was about NT$3.5 billion, benefiting approximately 90,000 patients every year. Total expenditure on new oral drugs for HCV is about NT$20.2 billion, benefiting more than 110,000 patients.

The physical and mental pain these diseases bring to patients and their families and the financial pressure of how to obtain the best medical treatment cannot be overlooked. Providing the best drugs and treatments for patients in need remain the primary goals of the NHIA.

Taking a closer look at outpatient medical expenditures in recent years, the breakdown shows that reimbursements towards medical professionals’ diagnostic fees accounted for only around 17.7 percent each year, with the ratio seeing continued declines each year. Concurrently, the proportion of expenditures taken up by drugs and medical exams and tests accounted for 27.2 percent and 12.5 percent respectively, with both categories seeing continued gains each year. The outcome suggests that a significant portion of NHI resources is being allocated towards machines and drugs that do not require labor or professional abilities. If the situation persists, the NHIA and the medical community will address the matter more seriously.

Minister of Health and Welfare Chen Shih-chung has proposed three major reform directions, comprised of:

• Reduce wastage of medical resources by the government’s cloud system to promote the sharing of medical resources and prevent improper consumption of medical resources
• Improving fairness of payments by reviewing copayments for medical treatment as well as by reviewing the rights and obligations of citizens traveling abroad terms of accessing NHI resources
• Raising the quality of health care services by integrating the public health system, to bolster disease prevention, treatment and end of life care

Meanwhile, the government’s drive to implementing the user pays principle is in line with the objective of improving the fairness of how NHI expenditures are shouldered, which mainly rests on the younger generation. By introducing checks to demand for treatments and drugs through pricing and improving communication between the patients and medical service providers, higher public awareness of the overuse of NHI could be achieved.

Looking ahead, the cap on drug copayments could be raised from the current NT$200 to a more tangible amount that will raise public awareness of the true cost of drug prescriptions. In addition, while copayments have not been required for medical examinations and diagnostic tests, a fee schedule could be introduced in the future. Other proposals being discussed include the resumption of copayments for patients with recurring drug prescriptions for chronic conditions as well as canceling copayment exemptions for patients with catastrophic illnesses or injuries.

The push for the user pays principle is not for the purpose of increasing the NHI’s income, but to prevent the seeking and prescribing of unnecessary medical treatments. Once achieved, improvements to the quality of health care services can be expected as medical professionals will have more time to address patients’ needs and medical professionals could also benefit from being provided with reasonable compensation for their work.

The NHIA will continue to carry out its mission to protect the rights and interests of disadvantaged groups and will also look forward to seeking consensus through social dialogue and identifying other disadvantaged groups that require assistance. While illnesses cannot be avoided entirely, how best to effectively protect the health of citizens remains the responsibility of the government. A collective effort is needed to maintain the sustainability of the NHI.

[2021-01-11/United Daily News]