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Sun, Oct 16, 2005 - Page 4 News List

Toward a healthier, leaner NHI

INTENSIVE CARE Taiwan's ailing health care system clearly needs attention, but what changes should be made? Two experts give their opinion on reforms


Fritz Britt making a speech on Sept. 24 at the Far Eastern Plaza Hotel in Taipei.


In recent years, the National Health Insurance program (NHI) has faced mounting financial woes, leading to talk of increasing premiums and plans by the Bureau of National Health Insurance to exclude certain non-essential medication from NHI coverage.

In an exclusive interview with the Taipei Times, Fritz Britt, head of the Novartis Policy Office, Novartis AG, and Stefan Ziegler, Novartis Asia-Pacific regional head, talked about their thoughts on Taiwan's NHI system and how it compares with European health care systems.

Analyzing the cost distribution of the NHI, Britt said that he felt Taiwan was very "hospital heavy," meaning that the system favors the hospitals.

"Hospitals tend to be pretty expensive. In all the health systems I have seen, if you have [a scenario in which] you shift power to one of the players, then it's going to be more of a power game than a real balanced system. My experience of European systems is that you would rather have a balanced hospital and [clinic] system," Britt said.

According to Britt, 20 years ago in France the trend was the same, with hospitals tending to grow ever bigger. As a result, regulations were brought in to restrict hospitals to a certain growth rate. Britt said in comparison, hospitals in European countries such as France, Italy, Spain and Germany are far more closely controlled by the state, and subject to far more regulation.

"We don't want to jeopardize [clinics] because it's the [combination of hospitals and clinics] that makes treatment cost-efficient, and not [a health care system] in which the hospitals have a monopoly," Britt said.

Pointing to another "bucket" of costs, Britt talked about how Taiwan's NHI covers a broader range of services than other, more established systems in which services are more narrowly defined.

"Even in France or Italy -- the traditional total coverage systems -- they are now saying that [certain] treatments are privately paid for, that they are not covered by the reimbursement system. In the drug field, these are the over-the-counter drugs, the drugs for coughs colds, headaches -- the day-to-day types of drugs," Britt said. He went on to suggest that a good move for Taiwan would be to have some non-essential drugs being paid for "out of pocket."

"[Taking] these treatments out of the system means you free up money for the really costly interventions. This way you can really get rid of the financial pressure," Britt said.

Aside from regulatory changes, Britt and Zeigler emphasized the role which investment plays in cost containment.

"If you look around, the companies which survive are not only cutting costs, they are also investing in opportunities," Britt said.

By way of example, Britt pointed out that although advances in medical treatment and new types of drugs are expensive, they help to offset costs in other areas by reducing the length of hospital visits and keeping NHI members in the workforce.

"Innovation is probably the key to overall cost containment," he explained.

In Europe, where cost-cutting has been taken about as far as possible, efforts are being made to improve working methods and to use treatments and drugs that lead to shorter treatment loops.

Britt and Ziegler stressed that cost containment rather than cost-cutting was the goal, since with the increase in the number of diseases and the ageing population it was natural that the health system should grow -- preferably at a proportionate rate to the GDP.

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