Healthcare providers have been calling on the government to guarantee that the value of each National Health Insurance (NHI) point is at least NT$1 to save the nation’s healthcare system, so lawmakers have proposed bills to ensure one point is worth at least NT$0.95 or NT$1. However, this would increase the NHI budget by between NT$70.5 billion and NT$115.5 billion (US$2.19 billion and US$3.59 billion) per year, which could harm its global budget payment system.
There seems to be a consensus that the guaranteed NHI point value must be increased. However, how it should be budgeted for and what supplementary measures are needed is still up for discussion.
The NHI’s payment system is an “expenditure cap” system with “floating” point values, used to precisely match the predetermined annual budget, as the total expenditure claimed by healthcare facilities for their medical services is reimbursed based on an adjusted amount multiplied by the point value.
During the COVID-19 pandemic, medical services for COVID-19-related conditions were covered by a special relief fund, but as the disease was downgraded last year, payment for medical services reverted to the NHI system. However, the increase in service volume diluted point values to nearly NT$0.7.
Facing protests by healthcare providers, the Cabinet in November last year approved an additional budget of NT$5.13 billion to make up for deficits last year, supplementing the point value and raising it to NT$0.9, and promising that it would remain at least NT$0.9 this year.
However, eight healthcare providers’ associations earlier this month issued a joint statement, urging the government to change the NHI’s global budget payment system to a “expenditure target” system, meaning that when the point value is less than NT$1, the government should make up the deficit.
Chinese Nationalist Party (KMT) legislators proposed two amendments to the National Health Insurance Act (全民健康保險法), which would ensure that one NHI point would equal at least NT$0.95 or NT$1.
The bills were first reviewed in a legislature committee on May 2, but no consensus was reached. The first cross-party negotiation was held on Wednesday last week, in which the government was asked to propose solutions within a month.
However, with global inflation, soaring commodity and housing prices, a low birthrate and a shrinking working-age population, raising the NHI premium is an issue that the government tries to avoid. More funding adds an extra burden on taxpayers and crowds out funding for other essential services.
National Health Insurance Administration Director-General Shih Chung-liang (石崇良) on Wednesday last week said the agency is considering adjusting the supplementary NHI rates to be equal to the standard premium rate, but further discussions would be needed.
Some consumer groups have said that a fixed NHI point value would undermine the NHI’s global budget payment system, incentivizing hospitals to pursue service quantity over quality.
Some experts proposed reducing the NHI budget in areas such as new technology and drugs, and preventive screening tests, which they believe should be covered by specialized government budgets, while some pharmacists also called for prescription drugs to be removed from NHI coverage.
The government, healthcare providers and civic groups all agree that there is a pressing need for NHI reform, but whether a guaranteed NHI point value should be adopted, partially adopted or other measures should be introduced is a big decision for the new Cabinet.
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