Pharmaceutical News
To save the NHI, the public must also strive to lower the number of medical visits each year
2022/01/07

Li Po-chang/NHIA Director General

 

The finances of the National Health Insurance (NHI) system are managed under a concept where total expenditure is capped by a fixed global budget, with medical services compensated in form of medical points. However, the amount of medical points claimed by health care providers has outpaced the caps allotted by the global budget by around NT$60 billion each year. As medical professionals and institutions cannot be expected to continue providing services while being denied of fair compensation, the public must shoulder some of the cost through copayments to ensure the quality of health care.

 

Statistics show that the number of outpatient visits made each year by beneficiaries rose from an average of 14.7 in 2006 to 16.7 in 2018, far exceeding the average of 6 visits per year in Europe and in the U.S. Furthermore, in 2018, outpatient visits made up 66.6 percent of health care expenditures, with inpatient stays making up 33.4 percent. By contrast, in Europe and the U.S., the breakdown of outpatient and inpatient expenditure were 45 percent and 55 percent in 2018, which indicate that there is much room for improvement in improving how resources are being used in Taiwan’s NHI.

 

The motivations behind the implementation of the copayment system are not only to increase revenue to alleviate NHI’s financial distress, but to also serve as a mechanism to modify the behaviors of providers as well as beneficiaries in accessing and provision of medical resources. Through better implementation of the referral system and the separation of prescribing and dispensing of drugs, as well as copayments, it is hoped that a new appreciation of medical resources may be cultivated and that beneficiaries will begin consulting with physicians on the necessity of diagnostic tests and treatment.

 

It is estimated that if the number of medical visits per person is reduced by one visit each year, annual health care expenditure can be reduced by NT$108.39 billion. Additionally, the NHIA will use business intelligence tools to conduct real time monitoring of how resources are being allocated towards hospitals and establish early warning mechanism for abnormally high consumption or irregular claims. The NHIA will also continue to urge hospital operators to refrain from prioritizing on patient volume.

 

The medical and pharmaceutical industries are both critical and hopeful of the future of the NHI. As a surgeon, I understand that some changes are impossible without reform. We need to pragmatically approach the NHI’s blind spots and address its challenges together with the medical community as well as the public.

 

[2022-1-3/United Daily News]