By Lee Po-chang, Director General, National Health Insurance Administration

Each year, the National Health Insurance (NHI) global budget growth rate is set within a range approved by the Executive yuan. The National Health Insurance Committee (NHIC) then determines the allocation of the global budget within the aforementioned range for the Ministry of Health and Welfare’s approval. As each member of the NHIC represents the interests of their respective stakeholders groups, changes in NHI premiums and funding must be thoroughly discussed in NHIC meetings according to the law.

Having worked at the National Health Insurance Administration for the past four years, I am deeply aware that emotions often run high during discussions about the NHI. All too often the medical community has complained that the price of cardiac massages has fallen below that of foot massages, while proposals to allocate funding from the global budget to adjust reimbursement standards for treatments of sudden, catastrophic and rare conditions are often met with opposing opinions among different levels of medical service providers.

Changes in NHI policies must accommodate the needs of all stakeholder groups, a complex undertaking with many facets to consider. The stakeholder group of premium payers alone is comprised of employers, labor, and the government, while the need to implement different reimbursement schemes to suit the needs of different patient groups adds further complexity.

The conclusion of discussion over the second-generation NHI resulted in calls to preserve the solvency of the NHI without reductions in reimbursements and without increases to NHI premiums. However, we must face the question that without the options of increasing the NHI premium, raising caps on copayments, canceling the copayment exemption for patients with catastrophic illnesses, collecting copayment on recurring drug prescriptions and charging copayments for diagnostic tests, where will new funding sources be found for new drugs to treat cancer and rare diseases?

The only way forward is to manage these challenges of the healthcare ecosystem pragmatically and pursue continued reduction in unnecessary treatments as well as provide fair compensation for medical service providers.

[2020-08-28 / Apple Daily]