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Hospitals threaten insurance pullout

Hospital representatives yesterday threatened to end their contract with the Bureau of National Health Insurance (BNHI) to protest the movable rate used to calculate the compensation hospitals receive for their services.

"The way the system works, hospitals have to pay their expenses first, and then later, depending on the total amount of medical expenses incurred, a rate for which hospitals are compensated is decided," said Victor Chang (張煥禎), a spokesman for the Taiwan Community Hospital Association.

"It's as if you pay NT$1,000 ahead of time only to find out later that you will only be compensated NT$900," he said.

The amount of compensation is determined using a system under which hospitals are accorded a certain number of points for medical expenses incurred.

According to the association, the rate of compensation that the BNHI recently announced to cover the first three months of last year averaged NT$0.8847 per point for emergency services and NT$0.9872 for in-patient services.

Doctors representing such institutions as Cathay General Hospital, Cheng Hsin Rehabilitation Medical Center, Taipei City Municipal Wan Fang Hospital and Tzu Chi Hospital, among others, announced plans to pull out of the health insurance system.

Hsieh Wen-hui (謝文輝), head of the association, said he was confident that some 400 hospitals would participate in the protest.

The protesters also aired their grievances yesterday afternoon at the campaign headquarters of the presidential and vice presidential candidates.

"Nowhere in the world is a movable rate used with no limitations to its fluctuations. When the compensation rate drops below a certain point, there needs to be government subsidies for medical expenses," Chang said.

"In addition, as the demand for medical treatment grows, either the total amount budgeted for medical expenses must increase or people have to adjust the frequency with which they visit hospitals," he said.

Hsieh said the movable-rate system hits district hospitals hardest, with 59 percent of these hospitals losing money.

In response, the bureau's Vice President and Chief Operating Officer Liu Chien-hsiang (劉見詳) said the compensation rate was rising.

He cited figures to show that while the reimbursement rate for the first three quarters of last year had averaged NT$0.98 per point and it had been NT$0.96 per point for the same time period in 2002.

"In addition, the total amount budgeted for the national health insurance at hospitals has continued to increase. Last year, it rose 4.5 percent," Liu said.

He added that if hospitals decided to pull out of their contracts with the bureau, patients would have to pay for medical services on their own.

Hsieh suggested that the bureau work out an arrangement that would allow it to directly reimburse patients for their medical expenses, instead of hospitals.

Liu said such a plan would be impossible to implement.
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