After unsuccessfully trying to collect National Health Insurance (NHI) fees from counties that owe the Bureau of National Health Insurance (BNHI,
It is the local governments that owe the BNHI money, not the hospitals. Moreover, if the government delays payments to the hospitals, it will breach the contracts it has signed with them and will seriously impede the hospitals' daily activities. The sick and infirm in the more remote reaches of Taiwan will ultimately be the ones who suffer.
Any solution to the problem must include restructuring health fees and rearranging the distribution of government revenue to different levels of government, while also taking into account the idiosyncrasies of individual politicians.
NHI fees are shared by the government, employers and the insured. The actual amount paid for by the government is very complex calculation, however, and the central, provincial, and county or city governments pay different percentages depending on the type of job held by each of the insured as well as other variables.
There is no clear reason behind the complex fee system. The formula was originally designed as a way for the various levels of government to share the fiscal burden of providing nationwide care. There was no consideration of the income disparities of different counties.
Some county commissioners have said that they are not withholding payments on purpose, they simply lack funds. How can they be expected to pay NHI fees if they barely have enough money to cover their employee paychecks?
But this line of reasoning is less than persuasive. Some of Taiwan's poorest counties, including Miaoli and Penghu, are able to pay their NHI fees on time, even though they are enraged at the heavy burden.
The two people most responsible for racking up huge debts to the BNHI are former Provincial Governor James Soong
Soong's reason for withholding payments to the central government was that local governments had not been asked their opinions before the insurance law was drafted but they still had to foot the bill.
With the present distribution of government revenue as it is, most local administrations depend on monies disbursed from the Overall Planning Fund
Why doesn't the central government just shoulder the entire burden of NHI fees while lowering its subsidies to local governments?
This would cut out a lot of red tape and would prevent the personalities of a number of politicians from becoming an issue. Under pressure to get re-elected, local politicians often give precedence to infrastructure projects and other high visibility projects. NHI fee payments and even government employee paychecks are put on a back burner. If local governments run short of money to cover their budgets they just ask for more from the Overall Planning Fund, complaining they don't have enough to cover paychecks.
After the provincial government was downsized, the central government took on the responsibility of paying its NHI fees, but not the NT$8 billion in unpaid fees still owing from Soong's administration.
Kaohsiung Mayor Frank Hsieh (謝長廷) also claims that budget shortfalls have left him unable to pay the NT$3 billion in back fees that accumulated when Wu was mayor.
The poor planning that went into the fee structure has left a number of local governments in arrears in their payments. Collectively, they now owe the central government NT$28 billion.
We suggest that the overdue fees be paid out of the Overall Planning Fund. Whatever is left over should then be distributed to local governments according to a clear formula. This would secure funds for the BNHI and increase the fiscal responsibility of local governments.
Lee Ying-yuan is a legislator and Chen Honda is chief of Lee's staff at the Legislative Yuan.
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