Fri, Jul 23, 2004 - Page 2 News List

Health insurance system faces cost pressure

LIVES AT STAKE As hospitals face new limits on government reimbursement, some patients with rare and chronic diseases are having trouble getting their medication

By Wang Hsiao-wen  /  STAFF WRITER

Despite Department of Health Director-general Chen Chien-jen (陳建仁) hailing Taiwan's health insurance plan as fit for a "health utopia," the Bureau of National Health Insurance's (BNHI) new president, Liu Chien-hsiang (劉見祥), says much needs to be done to keep that vision in sight.

"Taiwan faces common problems shared by other countries' health systems, such as rapidly growing expenses due to an aging population and medical advances in recent years," Liu said yesterday after assuming his new job.

According to Department of Health statistics, the bureau has been in the red since it was launched in 1995. Since 2000, the BNHI's deficit per month has exceeded US$100 million. Taiwan spends about 5.4 percent of its GDP on health care, with just under 4 percent coming from the public coffers or premiums paid by businesses.

Yet 96 percent of the nation's population of 23 million is covered by the insurance plan. Co-payments by patients range from NT$50 for a visit to a clinic or dentist to NT$19,000 for 30 days in a hos-pital, with upper limits on how much someone pays and special provisions made for the indigent or those with catastrophic long-term illnesses.

The system's wide coverage and low co-payments have weighed heavily on the BNHI. With no sign of rate increases this year, the bureau's current safety reserve is expected to be all but depleted by the year's end.

One way to lower the bureau's expenses is to limit the total amount allotted to hospitals, regardless of how many patients are served. In the past, easy and cheap access to medical care gave rise to abuse of the system, with most Taiwanese making more than 15 visits a year to a doctor.

"The sub-category of common colds alone cost the bureau NT$20 billion," said Wu Ming-yen (吳明彥), chief executive of the Taiwan Hospital Association.

"The insurance coverage is too wide for a fledgling health care system," said Wu.

By setting a budget quota for hospitals, the bureau intends to minimize waste of medical re-sources and encourage only patients with severe, rare or chronic diseases to go to hospitals. "We hope medical practice can become cost-effective, and we will work to establish the family doctor sys-tem," Liu said.

Since the BNHI enforced the fixed quota policy on July 1 it has met with criticism. The prescribed budget can lead to unequal delivery of medical care and marginalization of patients with severe or rare diseases. Many hospitals reportedly have turned down patients requiring expensive medications and long-term hospitalization to save money.

"We have received many complaint calls from patients with rare diseases. No hospital is willing to take them because drugs to treat them are simply too expensive," said Yang Yung-hsiang (楊永祥), the deputy chief executive of the Taiwan Foundation for Rare Diseases.

"Usually, they need to run to different hospitals and collect prescribed medicines to survive this month. The next month will be another battle," Yang said.

According to Liu, the bureau is reviewing a proposal to separate the NT$300 million allotment for over 3000 patients with rare diseases from the total budget. By treating the subsidies for this particular group independently, the BNHI can ensure that patients with rare diseases will receive treatment.

Others worry that the measure might not be enacted in time to save lives. "We appreciate the BNHI's support, but before the draft is ratified, many patients are dying from lack of medication," Yang said.

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