Pharmaceutical News
NHI expenditure doubled after 20 years of implementation

Reported by Lin Hui-Cin and Wu Liang-Yi


The NHI has been implemented for 20 years.  Health professionals estimated that the total health spending will reach NT$1.1 trillion this year, including NT$600 billion paid by the NHI and NT$500 billion paid by patients.  Healthcare reform groups criticized hospitals for making huge profits from both the NHI system and patients.  The NHI’s most outstanding performance is to make hospitals wealthy, said the reform groups. 

The NHI global budget increased from NT$300 billion to NT$600 billion over the past 20 years.  However, the cost paid out of patients’ pocket also increased sharply.  Teng Xi-Hua, the spokesperson of the NHI Supervision Alliance, said that the ratio of self-funded medical treatments increased to 36% in 2011.

Dr. Andrew T Huang, the Superintendent of the KFSYSCC, pointed out that the ratio of health spending to GDP has been about 6.6% for three years in a row.  At this rate, it is estimated that this year’s total health spending will reach NT$1.1 trillion based on the forecast of the GDP at NT$16.8 trillion.  As the NHI set this year’s global budget at NT$600 billion, the rest NT$500 billion will come out from patients’ pockets. 

According to the data from the MOHW, more medical devices/equipment has been purchased.  Taking positron emission tomography (PET) for example, the number of PET scan machine increased from 34 sets in 2008 to 42 sets in 2013.  The total number of patients undergoing PET scan increased from 28,334 to 34,970.  A good profit margin has lured hospitals into an arm race as hospitals compete with each other in equipping themselves with medical devices / equipment, said Prof. Yang Chi-Ling of the Asia University.

Chen Chen-Hui, a specialist of the NHIA, expressed that there were 109 hospitals which claimed over NT$600 million of NHI payment for medical services; furthermore, among all hospitals, 89% had a budget surplus.

Taking the outpatient and A&E departments of the Chang Gung Memorial Hospital for example, the revenue from the NHI increased from NT$17.1 billion in 2005 to NT$22 billion in 2011, up by 29%.  Revenue from non-NHI reimbursed services increased by 55%, from NT$3.3 billion to NT$5.1 billion.  Chi-Mei Hospital also had a similar trend.  For outpatient and A&E departments, the revenue increased by 38% (to NT$4.4 billion) and 100% (to NT$1.2 billion) in the NHI and non-NHI sector respectively.  It showed that hospitals have been making a profit from both the NHI system and patients.  Even the NTUH, a public and teaching hospital, had an annual surplus of NT$1.3 billion. 

Prof. Chiang Tung-Liang of the Institute of Health Policy and Management of the NTU expressed that the health industry has attracted huge investment since the implementation of the NHI.  The investment helps sustain and boost the growth and development of the health industry.  However, Prof. Chen Mei-Shia of the Department of Public Health of the NCKU expressed her concerns.  She said hospitals are more and more like department stores.  They are after profits and commercialize medical services.  It may distort the public’s concept of medical services, warned Prof. Chen.

However, Yang Han-Chun, President of the Taiwan Hospital Association, stressed that the reimbursement prices of medical services are still quite low in Taiwan, compared with the prices in other countries.  Hospitals cannot survive solely on the NHI market.  They have to create other income sources by satisfying some consumers’ needs, such as beauty clinics and high-end health check-up services, said Yang.


【2015-03-23/ Liberty Times】