Sun, Jan 25, 2009 - Page 8 News List

‘NHI 1.5’ alone won’t be enough

By Huang Chiang-hsiang, Liu Mei-chun 黃經祥 劉梅君

At the end of a year troubled by economic hardship, newspaper reports say the government will push its “National Health Insurance [NHI] Version 1.5” in an attempt to expand the revenue base and raise the contribution rate of the middle class to relieve the financial difficulties of the poor.

On the other hand, the government has failed to launch a thorough inquiry into longstanding public dissatisfaction with the high year-end bonuses for Bureau of National Health Insurance (BNHI) staff.

This dissatisfaction is a result of the NHI’s financial losses, increased premiums, the poor quality of medical services and the lack of public involvement in NHI policymaking.

To solve the problem, the government wants to turn the BNHI into an agency directly under the Executive Yuan, but that will only make the matter more complicated.

With this temporary, shortsighted and misdirected approach to changing the NHI, it is worrying that the government — after more than half a year in power — still hasn’t drawn up a comprehensive blueprint for the NHI program.

Will the insurance system, which has been called a social safety valve, drift farther and farther away from meeting the public’s needs?

Justice and quality are the two cornerstones of the NHI program. In the 13 years since the program was implemented, the government has never been able to effectively contain the waste of medical resources and irregularities of the system.

Because of an opaque process when making decisions and a lack of a connection between income and spending, the committee deciding on the BNHI’s NT$460 billion (US$13.7 billion) expenditure has degenerated into a body where medical sector managers exploit the benefits of the scheme under the table.

The government is required to launch reforms to increase the efficiency of NHI expenditure, but the effort has been halted by opposition from the medical sector. As long as these problems are not actively dealt with, it flouts social justice to begin by taking money from the public’s premium payments.

The public is often told that the NHI program is useless and that people must pay for things themselves because they are not covered by the NHI program. However, the receipts they get from the hospital are either not detailed or hard to verify.

Often when someone insured by the NHI must be hospitalized, they find it hard to find an NHI-insured bed, yet it is impossible to check the availability of NHI beds.

Medical quality reports requested by the public and academics do not address the issue and provide only limited information.

This makes one wonder what has improved as a result of the annual 5 percent increase in NHI premiums. In addition, grassroots medical personnel often complain that medical sector managers hold back on medical service manpower and quality to reduce cost while the public still has to pay its NHI premiums.

The NHI program has suffered financial losses of around NT$30 billion and the public must shoulder the burden of increasing premiums. A lack of information about medical service quality makes the public feel lost when seeking medical treatment. Little wonder that people are greatly disappointed by the NHI program and feel indignant at the high year-end bonuses given to BNHI employees.

The Taiwan Health Care Reform Foundation thinks that the second-generation NHI program proposed by various industries enjoys public support because it involves public participation, a connection between income and expenditure and a balance between rights and duties.

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