By National Health Insurance Administration Director General Lee Po-chang

Under the leadership of Minister of Health and Welfare Chen Shih-chung, the National Health Insurance Administration (NHIA) has drafted reforms to the copayment system, aimed at modifying the public’s health care seeking habits through the better implementation of the referral system, the separation of prescribing and dispensing while ensuring the interests of disadvantaged groups, so that large scale hospitals and medical centers can return to their primary role of providing acute and critical care.

With an aging population and the growing complexity and widening diversity of diseases, expenditure on outpatient visits have been rising steadily in recent years, while contributions from copayments have been declining each year, dropping to around 6.5 percent total medical expenditures. Data from recent years show that drug prescriptions and diagnostic tests take up around 40 percent of total medical expenditures, while compensation to doctors’ diagnosis have been steadily declining each year.

The primary objective of reforms to the copayment system is to promote the beneficiary pays principle, by encouraging patients with stable chronic illnesses to visit primary care clinics and to refill drug prescriptions at pharmacies to enjoy lower copayment compared to that of larger institutions above regional hospitals. Similarly, patients who have been referred to regional and larger scaled hospitals by primary care clinics will also be subject to lower copayments. In addition, emergency room patients assigned level one and level two rating will be subject to lower copayments compared to those with milder conditions assigned level four and level five rating. It is hoped that as a result, medical centers and regional hospitals can return to the role of providing critical care, and that patients with mild conditions will begin refraining from visiting emergency rooms at medical centers.

The proposed copayment reforms do not affect patients who are currently exempt from copayments, while the NHIA will continue to provide assistance to economically challenged groups by setting caps on copayments. Adjustments to the copayment system under the promotion of the beneficiary pays principle is vital in ensuring fairness of Taiwan’s social insurance system. It is hoped that the finances of the National Health Insurance can be improved following the implementation of the referral system, benefitting both health care providers and patients.

[2022-2-24/Liberty Times]