In a telephone interview with CM Media, Taiwan Pharmaceutical Marketing and Management Association (TPMMA) spokesperson Shen Tsai-ying, who is also a pharmacist, pointed out that the 2022 National Health Insurance (NHI) global budget is set to exceed NT$800 billion, with part of the funding coming from copayments. According to Article 43 of the National Health Insurance Act, NHI beneficiaries are required to pay copayment of 20 percent of the expense of each visit to health care providers, however, patients in 2019 have been paying an average of 5.8 percent. As a result of the NHI’s limited financial resources, many new drugs and medical technologies have not been included for reimbursement in a timely manner, subjecting many critically ill patients to high out of pocket expenses.

Shen Tsai-ying emphasized that if no reforms are introduced to the NHI, the system will collapse under mounting financial strain. “If NHI fails, the public will bear the brunt of consequences, as patients could be forced to switch to different drug prescriptions depending on changes in dispensing hospitals’ procurement policies,” Shen said. “First and foremost, it is necessary to clearly set the annual budgets for drug prescriptions and diagnostic tests,” Shen said, noting that while the budget allocation may lead to dissention over fairness, it could be improved and adjusted. Shen said that while predefined budget allocation may not be the best solution, it will deter certain trends in NHI finances, such as rising spending on diagnostic tests despite slow growth on drug expenditure and continued demands on drug makers to cut prices. This not only penalizes but also impede the development of Taiwan’s pharmaceutical sector, Shen added. Using the heart medication Imdur as an example, Shen said that the drug’s manufacturer has decided to exit the Taiwan market, leaving only locally made generics for patients. “The public contribute premiums to the NHI and they ought to have a choice in the medication prescribed, but instead the decision on drugs is now being controlled by hospitals’ procurement policies, said Shen.

Shen Tsai-ying believes that it is necessary for drug prescriptions to have meet copayment requirements. “Recently, there has been a decline in the amount of drugs that have been returned for disposal, which could be the result of fewer inpatient visits, or that patients with chronic diseases have been using previous prescriptions or stopped adhering to drug regimens and inpatient visits altogether, Shen said, noting that these developments deserve further investigation. She emphasized that drugs and diagnostic tests are only tools, and that in order for correct diagnosis, doctors should be allowed to have more time with each patient, therefore, doctors should be compensated based on the quality of care provided instead of quantity.

[2021-10-18/CM Media]