The negotiation result for the 2026 NHI Global Budget has been finalized at NT$988.335 billion, representing a growth rate of 5.5%. This year, the government has allocated NT$7.8583 billion for new health technologies, a reduction of NT$185.7 million, causing the proportion of this budget to the total global budget to drop from 0.86% to 0.79%. As new drug R&D continues to advance, this cut has raised concerns among patient groups about their right to medication. They worry that the reduced budget for new drugs could lead to treatment interruptions and stricter prescription requirements.

Prof. Chiang Dong-Ling of the Graduate Institute of Health Policy and Management at National Taiwan University noted that the NHI has long been beset by financial difficulties caused by three major factors: an aging population, advances in new health technologies, and rising social expectations.

According to Prof. Chiang, the NHI has a mission to ensure people’s access to medical care; however, it is also constrained by both the overall economy and individual economic efficiency. Since the implementation of the NHI, although the average life expectancy has not increased dramatically, the medically avoidable mortality rate has continued to decline. In fact, from 2000 to 2025, the gap between average life expectancy and healthy life expectancy in Taiwan has narrowed from 7.8 years to 7.4 years.

Although this gap is wider than in Japan, South Korea, and Sweden, it is similar to that in Canada, the Netherlands, and Germany. The United States, however, has a comparatively lower healthy life expectancy due to the absence of a national health insurance system. This highlights the importance of ensuring access to medical care.

From the perspective of the right to medical care, new drugs play a pivotal role. Ms. Wu Rong-Lai, President of the Taiwan Alliance of Patients’ Organizations and herself a dialysis patient, shared her personal experience, emphasizing that access to new drugs is crucial for patients with renal or autoimmune diseases. New drugs are effective in controlling disease progression, have fewer side effects, and can significantly improve quality of life.

Ms. Wu pointed out that some diseases are difficult to reverse or cure; therefore, for these conditions, slowing disease progression is crucial.

Funding for new drugs that are not related to cancer or rare diseases, covering a wide range of conditions, comes from several categories within the NHI global budget, including “new health technologies,” “changes in drug and medical material reimbursement regulations” (commonly known as the expansion of drug reimbursement coverage), and the recently added “temporary payment” fund.

Ms. Wu stressed that the growth of the budget for new health technologies should keep pace with that of the overall NHI global budget. Although she acknowledged that NHI resources are limited and tightly controlled, she emphasized that this specific budget should at least increase in line with the NHI global budget to safeguard patients’ right to medication.

Ms. Wu has observed an increase in the budget for the expansion of drug reimbursement coverage, which rose from NT$0.3 billion in 2019 to NT$2 billion in 2025. This growth rate surpasses that of the budget for new health technologies.

Ms. Wu noted that access to NHI-reimbursed drugs is not straightforward. For example, some drugs are only available to holders of the “severe injury card,” which requires various assessments and tests for issuance. Therefore, even if a treatment aligns with international guidelines, patients without the severe injury card cannot receive publicly funded treatment.

 Ms. Wu pointed out that when deciding whether a drug should be covered by the NHI, the authorities usually consider only the direct costs, such as drug fees and the number of patients, while overlooking other indirect costs. She suggested a more comprehensive evaluation that includes factors such as disease progression control and the reduction in hospitalizations or A&E visits, which could help lower overall healthcare expenses.

【2025-10-17 / United Daily】