Medical industry representatives on Monday urged the government to shift the National Health Insurance (NHI) “expenditure cap” system to an “expenditure target” system.
The representatives called for the transition to an “expenditure target” system with a service volume target and fixed point value to payment ratio, during a public hearing in Taipei.
“Extra expenditure” could be reimbursed at a reduced rate, they said, adding that these changes would require an additional budget of about NT$60 billion (US$1.85 billion), lower than the authorities’ estimate of NT$70 billion to NT$100 billion.
Photo: Fang Pin-chao, Taipei Times
This year, the budget for the NHI system is about NT$870 billion.
Under the expenditure cap system, the NHI has an annual fixed budget that covers five major categories of medical services: treatments provided in hospitals, clinics and dialysis centers, and by dentists and Chinese medicine practitioners.
The NHI reimburses healthcare facilities for services provided through a point value system. A point is convertible to New Taiwan dollars and the rate changes quarterly to align overall expenditure with the predetermined budget. Therefore, higher service volume results in a lower point value and lower payments to providers.
From 2018 to 2022, the average point-to-payout ratio for the five major categories of medical services ranged from about one-to-NT$0.8 to one-to-NT$1.2, but was about one-to-NT$0.91 most of the time.
This meant that many healthcare facilities were not fully reimbursed for their services.
Since the implementation of the NHI’s Global Budget Payment System about 20 years ago, the gap between medical demand and budget shortfall has been borne by medical institutions, Taiwan College of Healthcare Executives chairman Hung Tzu-jen (洪子仁) said.
There are pros and cons to the expenditure target system, National Health Insurance Administration Director-General Shih Chung-liang (石崇良) said.
For example, a hospital could opt to decrease the number of treatments offered to people when it nears its expenditure target to mitigate the costs associated with being reimbursed at a reduced rate, he said.
However, a uniform point value system, where the point-to-payout ratio remains the same, might lead to an unnecessary surge in services provided due to profit motives, Shih added.
The hearing came after Chinese Nationalist Party (KMT) lawmakers recently proposed two draft amendments to the National Health Insurance Act (全民健康保險法).
The amendments stipulate that one point should be worth no less than NT$0.95 or be equal to NT$1, and that any expenditure that goes over budget should be covered by the public purse — not medical institutions.
Minister of Health and Welfare Hsueh Jui-yuan (薛瑞元) on Thursday last week said he anticipated that if the bill were to pass, the fees for next year’s NHI could increase.
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