Pharmaceutical News
Graded healthcare and referral system are keys to the success of healthcare reform

Written by Lee Po-Chang, Director General of the NHIA


Two issues have attracted attention from healthcare professionals in the past six months.  They are the “named reimbursement assessment” and the “graded healthcare system”.  The first issue is about hospital’s NHI payment claims; and the second issue affects the healthcare providers and the general public. The “graded healthcare system” will effect a change in patients’ behavior and lead to a reform of the healthcare system.   The success of this ground-breaking healthcare reform rests on the public’s understanding and support.


Graded healthcare and referral system are implemented in almost every country where national health insurance is available.  The initial design of the NHI system in Taiwan also includes the concepts of the graded healthcare and a referral system; however, their implementation is not compulsory.  Therefore, patients make it a habit of rushing to big hospitals for ailments as big hospitals are easily accessible in urban areas.  This has resulted in an overcrowding problem in medical centers, and a shrivelling problem in health clinics and district hospitals. 


A shrivelling primary care sector

The data from the NHIA reveal a worrying trend.  In 2006, the ratio of outpatient services was 70.2% for primary clinics, 11.2% for district hospitals, 10.2% for regional hospitals and 8.4% for medical centers.  Ten years on, in 2016, the figures were 64.7% for primary clinics, 9.7% for district hospitals, 14.8% for regional hospitals and 10.8% for medical centers.  In Greater Taipei area, one in three patients seeks treatments directly from a regional hospitals or a medical center.


In response to the imbalance of the healthcare system, President Tsai highlighted in her Healthcare Whitepaper that the healthcare system has to be vertically and horizontally integrated, and the quality of community care should be improved.  Those policies are to prevent the primary care providers from losing out, and to direct medical centers’ effort to teaching, researching and treating severe cases. 


The implementation of the graded healthcare and the referral system is the only way to efficiently allocate resources.  Since last August, the MOHW and the NHIA have been working closely together to hold public hearing sessions and collect comments from legislators and experts.  Their relentless determination and effort have resulted in the “6 Major Policies and 24 Corresponding Measures” for the healthcare reform.


Promoting electronic referrals and sharing information

The NHIA has been promoting the “Integrated GP Service Program” since March 2003.  This program has reached over 2.6 million people so far.  This year, the NHIA is going to expand this program by encouraging hospitals to set up a 24-hour emergency consultation hotline and collaborate with other hospitals to provide joint outpatient services.  In order to encourage two-way referrals between hospitals so that patients can be directed to the right doctor and the right medical department, the NHIA has established a national patient referral platform.  Doctors can issue a referral letter on the electronic platform so that patients can immediately receive proper assistance from hospital’s referral counter.   The information of treatment and test results will be forwarded to and shared with the health clinic so that follow-up care can be provided for patients.


Adjusting co-payment to support patient streaming mechanism

In order to promote the mechanism for patient streaming, the NHIA gives incentives to patients who follow the referral system.  They will be charged a reduced co-payment in medical centers (reduced form NT$210 to NT$170) and in regional hospitals (reduced from NT$140 to NT$100).  On the other hand, patients who visit medical centers without a referral will have to pay a higher co-payment.


The adjustment of co-payment is not to boost the NHI income.  Rather, it is implemented to support the referral system and to change the healthcare ecosystem in Taiwan.  The reform is a long hard journey, and we need to make a start.  With the support from the healthcare industry and the society, we have a good chance to succeed and to provide quality care for everyone.


【2017-03-21 / United Daily News】