Given the financial challenges faced by the NHI, patients are experiencing extended wait time of approximately 2 years for new drugs. Adding to the complexity, the Financial Supervisory Committee has mandated that private actual expense health insurance should not set an upper reimbursement limit and should cover the entire healthcare expenses incurred by the insured. This directive has prompted many insurance companies to stop selling such policies, leaving patients at a disadvantage. Ms Tsai Shu-Ling, Deputy Director-General of the NHIA, acknowledged that due to the limitations of NHI resources, it is unfeasible to cover all service items. In response, the NHIA is exploring the possibility of implementing a top-up plan to offer an additional layer of protection to the insured. To address this complicated issue, the NHIA has commissioned the National Health Research Institute (NHRI) to conduct a thorough study and formulate a proposal.
Tsai Shu-Ling expressed that experts from various fields, including private insurance companies and the financial sector, are to be invited by the NHRI to study how to define the basic provision and the top-up plan and how to dynamically adjust the fees to reflect the constant advances of health technologies. The expert group will also consider whether the government should pay the premium for vulnerable groups. It will involve a significant structural change of the NHI system, and the process could be as complicated as setting up the NHI system. The NHIA intends to establish the top-up plan through a public-private partnership, signifying that the government will formulate the plan while private companies will handle its operation. Specific details are yet to be discussed.
Ms Tsai stated that private health insurance policies allocate more than 50% of the premium revenue to overhead costs. Typically, the public has to purchase various insurance policies to achieve comprehensive coverage. In response, the government will introduce a top-up plan for integrated insurance coverage. This approach aims to enhance efficiency compared to private health insurance and offer more affordability because of a larger insurance population.
Dr Hung Tzu-Jen, President of the Taiwan College of Healthcare Executive, noted that Australia's national health insurance system is also grappling with financial challenges. The Australian government addressed this issue by mandating that affluent individuals should purchase private health insurance plans; otherwise, they would incur a supplementary premium fee imposed by the government. To safeguard vulnerable groups, private health insurance plans in Australia calculate premium fees based on community rates. The Australian model could serve as a valuable reference for Taiwan.
Dr Hung expressed that the primary concern with the existing private health insurance plans is their exclusion of individuals with pre-existing health problems. The NHI top-up plan aims to address this issue by ensuring accessibility for everyone, including those with severe health conditions.
While acknowledging the concept of an NHI top-up plan, Dr Hung mentioned that it is still necessary to increase the NHI global budget to prevent "healthcare stratification". The top-up plan provides additional coverage to offer the insured more treatment choices; however there remains a concern about healthcare justice.
【2024-01-15 / United Daily】
