The NHI has always been a national pride. As the public expects the NHI to provide a full range of services at a very low cost, the NHI finds that it is getting more and more difficult to make new drugs available under the NHI benefit scheme. This is even more so when cancers now become a chronic condition and an increase of drug expenditure has a crowding out effect on the payments for healthcare professionals. How can the NHI solve this dilemma?
For example, Tagrisso (a treatment for non-small cell lung cancer) costs about NT$150,000 a month in Taiwan, while it costs just NT$66,000 in China. No wonder some patients would travel to China to get this medicine.
Yet, in Taiwan, the NHIA continues tightening the reimbursement criterion for Tagrisso. In 2020, the NHIA restricted the use of NHI-reimbursed Tagrisso to stage IV lung adenocarcinoma patients with EGFR mutations and no brain metastases. The criterion was changed again this year to stage IV lung adenocarcinoma patients with brain metastases. This change has reduced the eligible population by half, from 800 patients to just 400.
Dr Lee Po-Chang, the General Director of the NHIA, conceded that the reason behind a stricter reimbursement criterion is to stop a surge of drug expenditure. Since Tagrisso became available under the NHI, the total new drug expenditure jumped to NT$3 billion in the first year, and to over NT$4 billion in the second year, much more higher than the annual new drug budget of NT$2.2 billion.
Over spending on drugs will affect other budgets. “We all hope that cancer patients are able to access the best treatments; but, if we lose the control over drug expenditure, it will have a serious effect on the overall healthcare,” said Dr Lee.
That’s why some patients would take the risk of buying new drugs from unauthorized sources. Sadly, some fell victim to counterfeit drugs.
The world has seen a significant improvement in the cancer survival rates thanks to an increasing number of new treatments, such as genetic testing, targeted therapy, and immunotherapy. However, the people in Taiwan are rather underwhelmed by the NHI coverage.
Dr Lien Hsien-Ming, a professor at Department of Public Finance, National Chengchi University, pointed out that low investment in new technologies and innovative treatments has affected the quality of the healthcare in Taiwan.
According to the data from the World Bank, in the past two decades, the ratio of healthcare expenditure to the GDP grew by 28.77% in Taiwan, far lower than the growth rate of 109.37% in South Korea and 73.82% in OECD countries.
If the public sector spends too little on healthcare, the financial burden is then shifted to the general public. If Taiwan wants to keep up with its neighbour countries, there is still room for improvement in healthcare investment.
Insufficient investment in healthcare will affect the access to new drugs and new technologies, and undermine the development of the healthcare system. As a result, Taiwan is lagging behind many developed country in average life expectancy, cancer survival and neonatal mortality.
The NHI is the last line of defence, and it does not solve every problems. Starting to increase healthcare investment is the first step to improve the healthcare quality. Therefore, the government should try to nip the healthcare issues in the buds by upgrading the healthcare system. It is even more so in an ageing society.
【2022-09-15 / CommonWealth Magazine】
