Private health insurance has long been centered on inpatient admission as a prerequisite for claims, which is increasingly misaligned with the trend towards outpatient and home-based care. The Presidential Office’s Healthy Taiwan Promotion Committee (HTPC) recently reviewed progress on "improving the utilization of healthcare resources through private health insurance." Minister without Portfolio Chen Shih-chung noted that existing policies are often long-term contracts, making them difficult to abolish directly due to pre-established rights. Therefore, the policy direction is to develop new one-year, non-guaranteed-renewal policies to gradually phase out the old system.
Minister of Health and Welfare and HTPC Executive Secretary Shih Chung-liang explained that current inpatient health insurance still relies on "actual hospitalization" as the basis for actuarial calculation and payment. The established clauses are rigid and have difficulty in adapting to changing patterns of medical usage. On Sept. 17, Minister Chen Shih-chung convened an inter-departmental meeting with the Financial Supervisory Commission (FSC), the National Health Insurance Administration (NHIA), and the Life Insurance Association (LIA), where a preliminary consensus was reached.
Minister Shih outlined three directions for reform: First, asking the life insurance industry to develop the "one-year, non-guaranteed-renewal" new policy model; second, having the FSC provide policy incentives to mitigate product development risks; and third, enhancing data integration between the insurance sector and the NHIA to expedite the design of new policies.
To support the transition of private health insurance, the Ministry of Health and Welfare (MOHW) is providing cost data from various medical models, such as the Home-Based Acute Care Pilot Program and Outpatient Parenteral Antibiotic Therapy (OPAT), to serve as a foundation for new policy design. The goal is for reimbursement standards to move beyond the limitation of "inpatient status" and better reflect real-world medical utilization.
President William Lai also expressed concern over the transition progress during the HTPC meeting. Minister Chen explained that due to rapid changes in healthcare, insurers are reluctant to assume the uncertainties of long-term contracts. After extensive discussion, the decision was made to initially promote short-term policies, similar to group insurance, to clarify premium rates and risk assessment. These will be piloted first before considering broader expansion.
Furthermore, the committee reviewed the progress of other initiatives, including the next-generation digital healthcare platform and digital health and welfare infrastructure, as well as cross-hospital data connectivity and cost-sharing models. The Ministry of Transportation and Communications has approved Round-the-Island Route 2, scheduled for completion in 2026. Promotional materials are being planned for the "Healthy Taiwan, Happy Society National Exercise Routine." In the areas of smart healthcare and long-term care innovation, the government continues to promote investment through the National Development Fund and tax incentives.
【2025-11-27/ The Liberty Times】
