Despite the National Health Insurance (NHI) premium increasing to 5.17 percent on Jan. 1 last year, the system’s finances are again in dire straits.
The Ministry of Health and Welfare has proposed a package of reforms, including changes to the portion of NHI fees borne by the public and the provision of a safety reserve fund.
In addition to the “fixed rate system,” setting fees according to the level of the hospital where treatment is sought, tests and repeat or refill prescriptions for patients with chronic diseases are no longer to be completely exempt from fees.
In the current NHI system, the premium contribution ratio is calculated according to which classification the insured person belongs to, and is shared between the insured, their registration organization and the government. An individual could pay anywhere from 0 percent to 100 percent of the premium. The premium itself is calculated according to the individual’s payroll bracket.
Consequently, the level of the premium is unrelated to how much a given individual might abuse the system.
The ministry’s reforms could be an important tool in curbing the excessive use of medical resources.
However, increasing the portion borne by the public is something of a double-edged sword. If the portion is kept low, it would not have the desired effect; if it is too high, the economically disadvantaged would be less likely to seek medical treatment.
Let us look at the charges for emergency room treatments, in which the portion borne by the public for serious category 1 and 2 issues has been reduced, and for minor issues has been increased.
The problem is that most people have no way of discerning whether their issue is serious or minor, and head to an emergency clinic because they want their problem dealt with promptly. However, they could be deterred by the possibility of having to pay for an expensive visit. This concern is greater among the economically disadvantaged.
Even with an upper limit on fees or exemption conditions to ensure fairness of access to treatment, it would not be easy to strike the right balance.
For example, if the fees for tests or drugs are capped at NT$100 to NT$400 and NT$200 to NT$300 respectively, it would still be much less expensive than paying for the tests or medication oneself without insurance, but there is no guarantee that this will lead to less demand for more expensive tests or drugs.
Maximizing the cost benefits of how much a person pays for medical treatment is not conducive to reducing expenditures. After all, even if the portion borne by the insured is increased, part of the cost of treatment for serious illnesses, which accounts for a large proportion — 30 percent — of medical expenditure, would still be partly exempt, so this would not necessarily improve the NHI’s financial situation.
I am not opposed to the “user charge” system, which has the potential to reduce medical expenditures quickly, but in terms of addressing the financial losses of the NHI system from one year to the next, it is difficult to see what other alternative there is apart from increasing premiums.
The government should find a way to factor an individual’s accountability for their own health into the calculations of individual premiums, so that insured people who do not avail themselves to vaccinations and preventive medical services could have their premiums increased.
In this way, even if the NHI fund is not increased, at the very least people will be encouraged to look after their own health and reduce the burden they might place on the health system.
Huang Jui-pei is a dietitian and senior medical affairs officer.
Translated by Paul Cooper
US$18.278 billion is a simple dollar figure; one that’s illustrative of the first Trump administration’s defense commitment to Taiwan. But what does Donald Trump care for money? During President Trump’s first term, the US defense department approved gross sales of “defense articles and services” to Taiwan of over US$18 billion. In September, the US-Taiwan Business Council compared Trump’s figure to the other four presidential administrations since 1993: President Clinton approved a total of US$8.702 billion from 1993 through 2000. President George W. Bush approved US$15.614 billion in eight years. This total would have been significantly greater had Taiwan’s Kuomintang-controlled Legislative Yuan been cooperative. During
Former president Ma Ying-jeou (馬英九) in recent days was the focus of the media due to his role in arranging a Chinese “student” group to visit Taiwan. While his team defends the visit as friendly, civilized and apolitical, the general impression is that it was a political stunt orchestrated as part of Chinese Communist Party (CCP) propaganda, as its members were mainly young communists or university graduates who speak of a future of a unified country. While Ma lived in Taiwan almost his entire life — except during his early childhood in Hong Kong and student years in the US —
Chinese Nationalist Party (KMT) lawmakers on Monday unilaterally passed a preliminary review of proposed amendments to the Public Officers Election and Recall Act (公職人員選罷法) in just one minute, while Democratic Progressive Party (DPP) legislators, government officials and the media were locked out. The hasty and discourteous move — the doors of the Internal Administration Committee chamber were locked and sealed with plastic wrap before the preliminary review meeting began — was a great setback for Taiwan’s democracy. Without any legislative discussion or public witnesses, KMT Legislator Hsu Hsin-ying (徐欣瑩), the committee’s convener, began the meeting at 9am and announced passage of the
In response to a failure to understand the “good intentions” behind the use of the term “motherland,” a professor from China’s Fudan University recklessly claimed that Taiwan used to be a colony, so all it needs is a “good beating.” Such logic is risible. The Central Plains people in China were once colonized by the Mongolians, the Manchus and other foreign peoples — does that mean they also deserve a “good beating?” According to the professor, having been ruled by the Cheng Dynasty — named after its founder, Ming-loyalist Cheng Cheng-kung (鄭成功, also known as Koxinga) — as the Kingdom of Tungning,
RSS