By Dr. Chih-Liang Yang / Former Health Minister of Taiwan and currently a Chair Professor of Asia University
By its definition, the National Health Insurance (NHI) is a service provided to the general public. Therefore, it should be subject to the public’s supervision. Based on this concept, the design of the NHI system stresses the importance of the public’s involvement. The current NHI system uses the Health Technology Assessment (HTA) to evaluate whether medicinal products and medical devices should be covered by the NHI; and the final decision is made by the NHI Board, which consists of representatives of various stakeholders.
Money is the dominant issue
However, recent news reports revealed that the NHI Board members had a low attendance rate. The average attendance rate was under 1/3 of the total members. Some representatives hadn’t attended any meeting during their 2-year term of office. This is very disappointing as it undermines the efforts in increasing the public’s involvement. The reason behind the low attendance rate is largely due to the seriously unbalanced discussions in the decision-making process. As a result, those representatives whose opinions have long been neglected don’t feel the urge to attend meetings.
One of the key features of the 2G NHI is to include opinions from various parties to make the system complete. However, the NHI decisions have been dominated by financial concerns. The financial issues are overly exaggerated. Hospitals took a bossy and strong attitude to safeguard their profits. Fee payers are worried about increasing premium fees. The government is busy negotiating and coordinating resources. The intense wrestling leaves no capacity for serious discussion of health technology, healthcare quality, the relationship between doctors and patients, medical ethics, etc.
There are precedents for patients’ involvement
I was invited to attend a training course organized by a patient group. I was surprised that some patients’ knowledge of certain diseases is more detailed than many doctors. There is a lack of in-depth discussions about the effect of a new treatment on the quality of life, its side effect, the burden on carers, the choice of treatment methods, and the consideration of patients’ esteem.
Before amending the 2G NHI Act, the authority referred to the practices of patients’ involvement implemented in many advanced countries so as to create a pathway for patients’ involvement in discussion. It’s a shame that no consensus was reached to include patient groups’ comments due to the concerns of the quality and the bias of their comments. However, this problem can be easily solved. For example recruiting experts as representatives, forming patients’ alliance and including patients’ comments in the HTA report have been employed by the authorities in other countries.
The system is incomplete without patients’ involvement
There NHI is a social insurance. Therefore, the insurer, the insured, the beneficiaries and the guarantors should all have the right to express their opinions. However, the current system excludes patients from the discussion despite the fact that they have a genuine concern of healthcare quality. Such system is not complete.
Therefore, I would like to urge the patient groups to step forward and to unify their voices so as to defend their rights.
【2015-01-20/ United Daily News】