By Ling Yung-zen 林應然
The National Health Insurance (NHI) budget for this year is to be increased by a record 5.5 percent to NT$928.62 billion (US$28.17 billion), hitting the ceiling approved by the Executive Yuan and surpassing the negotiated version.
Many medical institutions are relieved by this outcome.
However, the Taiwan Healthcare Reform Foundation and the National Health Insurance Civic Surveillance Alliance said that the budget increase was “asking for 50 cents and getting a dollar.”
They even went so far as to demand an investigation into whether Minister of Health and Welfare Chiu Tai-yuan (邱泰源) is involved in corruption or otherwise contravening the law.
The Health Care Index by Country provided by online database Numbeo had Taiwan ranked first globally for the sixth consecutive year last year. Taiwan has ranked first on the list 12 times, surpassing Japan and South Korea.
However, long-term underfunding has led to a number of setbacks in the NHI system.
Reimbursement rates have fallen to between 70 and 80 percent, leading to a shortage of staff in many medical institutions as well as a reduction in services. A decrease in available hospital beds means that many people are unable to be admitted to emergency rooms due to overcrowding, while operating room hours have been limited.
Even members of the Legislative Yuan — regardless of party affiliation — have recognized the severity of the situation and have resolved to adjust the “floating point value” — a number used to calculate the reimbursement rate to healthcare facilities for medical services — in the NHI scheme to NT$0.95 by June 30.
Civil groups are genuine in their efforts to monitor increases in NHI expenditure, but it is also worth considering whether methods should be proposed to encourage the public to more reasonably utilize the NHI system, as its unrestricted nature has led to overly expansive coverage.
The lack of restrictions on medical referrals allows for direct and unlimited access to medical centers, like an all-you-can-eat outpatient buffet. As a result, the burden of increased health insurance costs has fallen entirely on medical institutions.
Such unequal oversight calls for serious re-evaluation.
The health insurance budgets of many countries operate on a system where medical services cease to be offered once the funding is used up. Such a practice often leads many medical consultations, tests, surgeries and so on to be delayed until the start of the next budget cycle. People must often wait months or even years as a result.
Taiwan is the only place in the world that allows unlimited access to healthcare, while medical institutions shoulder the expenses under the NHI budget system.
Hidden beneath the surface of the better than 90 percent satisfaction rate of the NHI system, Taiwan’s medical institutions are bleeding internally from withheld payments, deductions, reduced reimbursement rates and rejected claims.
If the Ministry of Health and Welfare fails to consider increasing the NHI budget, how can it expect to meet the requirements of the Legislative Yuan’s resolution?
Without a budget increase, how would the nation’s medical institutions survive?
There is no such thing as a free lunch. No matter how capable the minister is, the country’s medical system cannot meet its high demand efficiently and effectively without adequate funding.
Lin Yung-zen is the director of the Taiwan Primary Care Association.
Translated by Kyra Gustavsen
