Pharmaceutical News
NHI requires an overhaul to get out of a deep financial hole

“The NHI system has created an enormous financial black hole worth hundreds of billions,” said Prof Chang Hong-Jen of the Institute of Public Health of the National Yang Ming Chiao Tung University during a forum held on the 19th.  In the forum, many scholars presented various suggestions for improving the healthcare system, including creating an evidence-based NHI system, establishing a national-level think tank, supplementing the NHI with commercial insurance plans, etc.

A complete reform

Prof Chang Hong-Jen, former NHI Director-General and CDC Director, solemnly pointed out the dilemma that Taiwan is lagging behind other countries in health investment, however most people in Taiwan are against the idea of an increase in NHI premium due to concerns about being taken advantage of. 

Prof Chang continued that advances in health technologies have resulted in the introduction of many innovative and expensive new drugs and new devices, leading to a continual rise in treatment costs.  He candidly expressed that the current longevity is essentially purchased with money and would not be achievable without financial resources. His remarks are supported by the fact that Japan and South Korea outperform Taiwan in many health indices. 

According to Chang, the issues plaguing the NHI primarily revolve around its finances. The key concern is determining the required amount. A shortfall in the billions can still be managed, and a deficit in the tens of billions can potentially be addressed by raising the premium rate. However, the NHI is grappling with a shortfall of hundreds of billions, a situation that can only be rectified through comprehensive reform.

An NHI with commercial characteristics

Dr Wang Cheng-Hsu, President of the Hope Foundation, said that the NHI’s stringent reimbursement assessment has deprived many cancer patients of access to new treatments.  At the same time, commercial insurance companies are either withdrawing from the market or raising the premium.  Dr Wang reckoned that the government should adopt an approach which allows patients to supplement their NHI coverage with a commercial insurance plan. He suggested that the government should relax the underwriting conditions so that more people could be eligible for commercial insurance plans. 

Prof Lu Rei-Feng of the Department of Healthcare Management of the Chang Gung University mentioned that life-saving healthcare services should be provided by the NHI, while patients seeking for “additional comforts” should bear those extra costs themselves.  This aligns with the concept of user fees and market mechanisms.   In Australia, the government sets the healthcare premium at a community rate; and those whose income exceeds a certain threshold are required to buy a commercial insurance plan.

A dedicated think-tank

Jiang Chang-An, President of the NCTU Alumni Association, expressed that the global budget system put an obstacle to the R&D of new drugs and biotechnology.  He mentioned that the low NHI premium and reimbursement for treatments have led to structural issues which should be addressed gradually.

Prof Nicole Huang of the Institute of Public Health National Yang Ming Chiao Tung University pointed out that in the past, discussions about the NHI predominantly concentrated on identifying problems without offering solutions. She proposed that the government should establish a national-level think tank to develop evidence-based policies and strategies, including balanced-billing and tax subsidies.

【2023-09-19 / Taiwan Awakening News】