The National Health Insurance (NHI) employs a global budget system to balance its finances and to contain annual expenditure growth at manageable levels at between 2 and 5 percent. In the past two decades, annual NHI expenditure has grown 2.7 times from 252 billion medical points in 1998 to 672.7 billion medical points in 2018. Of which, annual drug expenditure also rose 2.6 times from NT$60.9 billion in 1999 to NT$158.6 billion in 2018, while medical consultation and diagnostic expenditure rose 3.7 times from NT$19 billion to NT$70.6 billion during the same period.
Although the National Health Insurance Administration (NHIA) in 2002 implemented copayments capped at NT$300, the measure was canceled on Jan. 1, 2004, which, following the change, led to a 2.5-fold increase in western medicine outpatient diagnostic expenditure from 28 billion medical points in 2004 to 70.6 billion medical points in 2018. As diagnostics and drug spending take up a large share of the global budget (74 percent), the amount of resources that can be allocated to medical personnel for the services they provide has been steadily declining, leading to the dilution of medical services medical points. In a bid to curb the wastage of medical resources, we will continue to advocate the patient referral system.
Excluding vulnerable and disadvantaged groups that need to be protected, the NHIA estimates that 364.49 million cases would be affected if a “fixed rate” copayment was implemented but also bring in additional 61.9 billion medical points in premiums and greatly help in balancing NHI finances. Although the change is not necessarily infeasible, implementation would require stakeholders’ consensus due to the sheer magnitude of anticipated effects.
With regard to adopting a “fixed amount” approach with higher caps and a “fixed rate” approach for some items, there are three policy options. The first option would be to cancel the copayment exemption for chronic illness refill prescriptions, which is estimated to affect 53 million cases and bring in 5.71 billion medical points in additional copayments. The second option will be to remove the cap on drug copayments, which will affect around 4.52 million cases and lead to 4.79 billion medical points in additional copayments. Currently, regulations stipulate that drug prescriptions exceeding NT$100 issued at medical institutions of all sizes are subject to a 20 percent copayment, while being capped at NT$200. Under these conditions, there are an estimated 4.51 million cases where the copayments due exceed NT$200. If the NT$200 cap is removed, an additional 4.78 billion medical points can be drawn from beneficiaries. The third option, which sets a 20 percent copayment requirement on diagnostic expenses incurred at regional hospitals and medical centers, would affect 33.84 million cases and lead to 10.6 billion medical points in additional premiums. The three aforementioned options are estimated to bring in additional income equivalent to 21 billion medical points from copayments. What is worth considering is that if copayments are increased, the public will be deterred from making unnecessary hospital visits, resulting in lower outpatient expenses as well as indirectly raising the value of medical points to provide reasonable reimbursement for medical personnel.
In setting policy changes, the NHIA must consider the perspectives of all public stakeholder groups and strike a balance in weighing the pros and cons of each proposal. The NHIA also wishes for the public to consider the equitability of the user pays pricing approach. While the global budget remains constant, the NHIA also hopes to provide patients with new and innovative drugs, medical devices and therapeutics. However, under financial constraints, new treatment options can only be selectively introduced. If adjustments could be made to the way copayments are calculated, medical services providers and members of the public could rethink the ways they are engaging with Taiwan’s medical resources.
[2020-02-28 / United Daily News]
