Thu, Nov 08, 2018 - Page 8 News List

Less doctor’s visits would save NHI

By Lee Po-chang 李伯璋

Thanks to the universal National Health Insurance (NHI) program, there are almost no economic barriers to seeing a doctor. Many people might not be aware that 1 million Taiwanese visit a doctor every day.

In a comparison of the number of people who sought medical treatment in the first quarter over the past three years, medical centers reported an increase from 7.029 million visits in 2016 to 7.344 million visits this year and metropolitan hospitals reported an increase from 9.684 million visits in 2016 to 10.123 million visits this year, while local community hospitals reported an increase from 6.345 million visits in 2016 to 6.663 million visits this year.

However, local clinics reported a drop from 50.574 million visits in 2016 to 48.881 million visits this year.

A look at the total number of visits to all hospitals and clinics in the first quarter of this year and the first quarter of last year shows that the reported number increased by 4.298 million.

In other words, the number of visits increased by an average of 47,000 per day — quite a substantial figure.

This analysis of NHI data shows that although the policies allowing hospitals full control of the global budget for hospitals and of regulations on reasonable numbers of outpatient consultations per physician — policies that have been in place for many years as ways to stop medical fees from increasing — the first of these two policies in combination with human weakness means that hospitals will do what they can to expand their services when the number of people seeking treatment does not meet the target figure, and this will always lead to more waste.

The reasonable number of outpatient consultations per physician is restricted through price adjustments, but most hospitals continue to expand their services to increase the number of people seeking treatment.

Numbers show that last year every Taiwanese sought medical treatment 15 times on average. In addition to this quite substantial number, those who also visited a local clinic did so nine times on average.

Under the global budget system, hospitals report their expenses as a point value rather than as a sum, and some in the medical sector are complaining that this means that the point value for NHI payments has been depreciated and now is less than NT$1 per point. However, the point value is dependent on the volume of services provided: The more medical services a hospital provides, the lower the point value.

Last year’s data for Western medicine outpatient consultations showed that if all outpatients visited the doctor one time less, the point value would increase from 0.9624 to 1.0180. If the number of visits went down by two, the point value would increase to 1.0805, and if it went down by three, the point value would increase to 1.1510.

If outpatients with chronic ailments or major injuries or illnesses were excluded, the point value would increase to 1.0147 if the number of visits dropped by one, to 1.0729 if the number of visits dropped by two and to 1.1383 if the number dropped by three.

In other words, it is not impossible for the point value to be greater than one per NT$1.

Most physicians in Taiwan are very attentive to their patients and often urge them to return for a follow-up and even set up a new appointment on the spot, something that is greatly appreciated by many patients.

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