The NHI in Taiwan is a health insurance system with the world’s highest coverage rate and a 90% satisfaction rate. Since the start of the NHI system in 1995, the nation’s average life expectancy has increased by 6 years and the 5-year survival rate of cancer patients has increased from 40.7% to 58%. The NHI also ensures that the vulnerable has the equal access to healthcare.
Yet, the NHI has been beset with financial problems as the expenditure always outgrows the revenue. Furthermore, in 2025, Taiwan will become a super-aged society. As the health technology continues advancing, the costs of tests and new drugs will keep growing. Though the NHIA increased the premium rate to 5.17% in 2021, the NHI annual global budget will cross the threshold of NT$800 billion in 2022. The insured is likely to face another premium hike next year.
Tsia Li-Juan, the Vice President of the Formosa Cancer Foundation, pointed out that the NHIA will face increasing challenges of providing new cancer treatments via its Benefit Scheme as the cancer population grows at a rate of one new patient at every 4 minutes 31 seconds. The challenges are:
1. The budget is insufficient, and it is difficult to increase the premium rate. In Taiwan, the overall health expenditures account for just 6.5% of the GDP (NHI accounts for 3.5%). This rate is far below the OECD average (8%-10%). Social, economic and political factors all hinder the increase of the premium rate.
2. The cost for cancer treatments continues growing. In 2020, it grew by 10% which was far higher than the growth rate of the NHI budget. Due to the financial constraint, the NHIA is slow in including new treatment into the Benefit Scheme.
3. Due to the crowding out effect, new cancer drugs need to provide strong evidence to be listed by the NHI. Surrogate endpoints and Real World Evidence could be used to support the effectiveness of new drugs. The NHIA needs to work out new approaches and reimbursement methods to help patients to access new drugs.
The Formosa Cancer Foundation conducted a study in 2019 to understand the public’s opinion about the co-payment for new drugs and new health technology. The study results reveal that 72% of the cancer patients support a co-payment of NT$5000 a month, and 67% would agree to pay NT$20,000 a month.
Tsai mentioned that the Foundation is now working on the establishment of a cancer drug fund (TmCDF), hoping to help more patients to access new cancer drugs. The TmCDF will have three major features: 1 greater involvement (to include patients, the NHIA, the industry, etc.); 2. the use of RWE for resource efficiency; and 3. shared financial burden.
【2021-10-06 / China Times】
