Sat, Jul 17, 2004 - Page 2 News List

Health payments spark dispute over autonomy

CONTRIBUTIONS Health authorities say Taipei City is legally bound to subsidize all its residents, but the city argues that the central government has duties too

By Wang Hsiao-wen  /  STAFF REPORTER

Following a ruling by the Supreme Administrative Court on Thursday that the Taipei High Administrative Court should review the dispute over Taipei City's contributions to the health insurance system, the controversy has boiled down to whether insurance subsidies are the responsibility of the central government or of local authorities.

While the Bureau of National Health Insurance (BNHI) argued that the city government's share of the insurance subsidy is a 10-year-old administrative convention with a legal basis, the Taipei City Government retorted that its contributions to the system had been a makeshift arrangement and that the bureau's insistence on payment violates the spirit of local autonomy.

"Article 27, No. 2 of the National Health Insurance Law (全民健康保險法) clearly states that special municipalities [Taipei City and Kao-

hsiung City] should subsidize 5 percent of the insurance fee.

It is Taipei City's legal responsibility to pay its debt," bureau president Liu Chien-hsiang (劉見祥) said yesterday.

Liu said that the law has regulated the ratio of insurance expenses payable by the central and local governments since it was launched 10 years ago.

The city government argued that the law did not apply to the city.

"The Council of Grand Justices Interpretation No. 555 makes it clear that the Taipei City Government has the duty to offer health care only to its residents. National health insurance is a nationwide system and its affairs extend beyond city boundaries," said Chen Ching-hsiou (陳清秀), chairperson of the city's Law and Regulation Commission.

At the heart of the debate are different definitions of insurance units.

"We can only afford to cover the health insurance of those who register their households in Taipei City. It is the central government's responsibility to cover the insurance of people who register their households in other counties but live in Taipei," Chen said.

From the BNHI's perspective, however, those who work and live in Taipei also have the right to the city government's care, regardless of where their household has been registered.

"The Taipei City Government has the responsibility of taking care of those who work in Taipei and who contribute to its prosperity. It is a matter of social responsibility," Liu said.

Their opposing stances revolve around a common problem -- both the BNHI and the city are experiencing problems balancing their books.

According to Deng Shih-hui (鄧世輝), general manager of the BNHI's financial analysis division, the bureau's current safety reserve of NT$10.5 billion is expected to be all but depleted by the end of the year.

"Before we make any moves, we need to consult labor unions, social groups and medical professionals over whether to adjust the insurance fee," Deng said.

Under pressure from all sides, the insurance rate has been pegged at 4.55 percent since 2002.

The bureau is concerned that raising fees could ruffle the public's feathers.

The Taipei City Government's bottom line reveals even more severe financial problems.

"The Taipei City Government's deficit has grown to more than NT$150 billion, a number equal to the total accumulated deficits of Taiwan's 15 counties," Chen said.

"The city would like to take all its residents under its wings, but rights and duties are complementary. Considering that the greater part of Taipei City residents' income tax and business tax go to the central government, it is unreasonable to expect the city to bear the brunt of residents' health insurance subsidy," Chen said.

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