For three years in a row, Taiwan continues to top the chart of the Healthcare Index published by Numbeo. Though the healthcare system in Taiwan is wildly praised, the NHI system has been beset with chronic financial problems. The Taiwan Medical Association and the radio station RTI jointly organized a forum to discuss the future of the NHI with a view to finding possible solutions.
In the forum, Vice President Lai Ching-Te talked about the causes of the spiralling healthcare expenses which include an ageing population, the availability of new treatments, an increase in demands, etc. According to Vice President Lai, in 2025, about 20% of the population will be over 65 years old. As the birth rate continues dropping, the changes in the demographics will certainly impact on the NHI.
As the population is ageing, the number of patients with cancers or chronic conditions increases. The NHI-reimbursed new approaches for treating cancers have put a heavy financial burden on the NHI. The NHI spends over NT$100bn on cancer treatments every year. A reform is certainly required.
Dr Chen Chien-Jen, a former Vice President and former DOH Minister, suggested three directions for a sustainable NHI: waste containment, fairness and quality. The cloud-based health record platform has effectively reduced the duplicated tests and prescriptions, as well as reduced the risk of drug interaction. From 2014 to 2020, NT$9.45bn were saved from the reduction of duplicated prescriptions.
Dr Shi Shu-Hua, speaking for the frontline healthcare professionals, expressed that the status of the NHI is quite ambiguous as it is a hybrid of insurance and social welfare. If the NHI is, as it named, a health insurance, then it should be the insured who pays for the service first and then applies to the NHIA for the reimbursement. In doing so, the insured will be able to know what drugs and treatments they are receiving. This will reduce the waste. The insured might complain about the administrative hassle; however, such a hassle could also be an obstacle which deters people from abusing the system.
In fact, the NHI has been in deficits for four consecutive years, and has been depending on its safety reserve. The NHI is expected to have a shortfall of NT$67.6bn in FY2020. Though the premium rate is now increased from 4.69% to 5.17%, the NHI is still on a very tight budget.
Prof Chou Yiing-Jenq of the Institute of Hospital and Health Care Administration of the National Yang Ming Chiao-Tung University pointed out that the public always demands that the NHIA should firstly try to cut down spending and waste before imposing any premium hike. This is a common fallacy, said Prof Chou. Increasing healthcare expenditure is actually a worldwide trend. The healthcare expenditure in Japan is about 10% of its GDP and the ratio goes up to 17% in the US. However, in Taiwan, we remain spending just 6% of the GDP on healthcare which is not enough to cover the advances in technology and new treatments. While containing the cost, the government should also consider reasonably increasing the health expenditure so as to provide better care and support the development of the industry.
【2021-04-27 / RTI】
