The highly acclaimed National Health Insurance (NHI) system in Taiwan celebrates its 30th anniversary this year. Mr. Huang Huang-Xiong, President of the Taipei School of Economics and Political Science Studies, noted at a seminar marking this milestone that NHI reform is currently in deep water, facing three major challenges: super-aging, low birth rates, and new technology. Experts at the meeting suggested that NHI reform should focus on adjusting insurance rates, improving the payment system, and accelerating the inclusion of new drugs and new technology.
Mr. Huang, who is also a member of the Control Yuan, published an NHI Review Report on the NHI’s 17th anniversary. More than a decade later, he now emphasizes that the NHI is at a critical moment for reform. A super-aging society increases healthcare expenditures, while low birth rates weaken healthcare revenue. The combination of these two factors creates intergenerational inequality, making the financial burden of the healthcare system unsustainable. Furthermore, new technology has triggered an arms race among hospitals, while new drug R&D not only raises NHI expenditures but also drives hospitals toward the self-payment market, deviating from the original purpose of the NHI system.
Ms. Joan Lo, an economist at Academia Sinica, stated that NHI reform ultimately comes down to increasing revenue and reducing expenses. However, previous reform attempts have been ineffective, as the financial sustainability of the NHI has relied heavily on strict cost control. This approach has had a serious impact on the healthcare ecosystem, leading to an exodus of healthcare professionals and a shift toward self-payment market. It is essential to thoroughly evaluate the necessity of the NHI global budget system.
Dr. Lee Wui-Chiang, the deputy superintendent of the VGH Taipei, expressed that healthcare investment in Taiwan is significantly lower than that of our neighboring countries, accounting for only 6.1% of GDP. As hospitals compete for the global budget, they have had to turn to self-payment services to cope with operational challenges. The number of clinics offering self-payment services increased from 1,157 in 2015 to 1,601 in 2023, with the proportion rising from around 10% to 13%.
Dr. Hung Tze-Jen, the Deputy Superintendent of Shin Kong Memorial Hospital, noted that the NHI must return to its original purpose of “self-help, mutual aid, and risk sharing.” This implies an adjustment of the premium rates so that high earners would share more social responsibilities. Moreover, the authorities should improve the payment system to adequately reward healthcare professionals and accelerate the inclusion of new drugs and technologies into NHI coverage. For example, the NHI could establish a ring-fenced fund for specific diseases to ensure swift access to new treatments without imposing too much financial burden.
Ms. Liu Shu-Qiong, the President of the Taiwan Healthcare Reform Foundation, expressed that the government should help the public understand healthcare costs to impose a fair premium fee. Healthcare providers are facing a challenging ecosystem under the global budget system. To remedy the situation, the government provides a guaranteed point value, which violates the core principles of the global budget mechanism. Ms. Liu suggested conducting a thorough examination of the global budget system and designing a reasonable payment system. Improvements should focus on three key areas: distribution justice, negotiation mechanisms, and accountability for effectiveness.
The Ministry of Health and Welfare (MOHW) launched the “individual global budget” system this year, aiming to resolve issues concerning the tiered healthcare system. Dr. Chiu Tai-Yuan, the MOHW Minister, emphasized that medical centers should focus on treating severe and complex cases while reducing the share of outpatient services.
【2025-02-22 / United Daily】
