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National health insurance deficit going up: minister

“The cost of caring for the elderly is three times higher than for younger people.” — Yaung Chih-liang, Department of Health minister

The nation’s national health insurance system will face a bigger deficit next year than the NT$55.4 billion (US$1.7 billion) shortfall expected this year, Department of Health (DOH) Minister Yaung Chih-liang (楊志良) said as he insisted that premiums must go up.

Yaung was responding to criticism from Democratic Progressive Party Legislator Hsueh Ling (薛凌), who on Friday accused the DOH of waffling on the issue of whether premiums would be raised.

Yaung had said on Thursday that the health insurance premium rate, currently set at 4.55 percent of an employee’s monthly salary, with an income ceiling of NT$131,700 per month, would not be increased for the moment, but that the premiums paid by high income earners would be hiked.

The “no hike” statement came just a day after Yaung drew fire from legislators across party lines for saying that the DOH had almost completed a plan to increase the insurance premium rate to 5 percent from next year to help prop up the country’s cash-strapped health insurance program.

Citing the conclusions made at a recent citizen’s conference, Hsueh on Friday insisted that “the national health insurance system must be maintained,” that “­government ­subsidies must not be slashed” and that “national health insurance premiums cannot be hiked.”

In response to Hsueh, Yaung said that raising premiums was not a question of whether he agreed with the idea or not, but simply something that was unavoidable, and he suggested raising premiums on high income earners.

Although the DOH head acknowledged that the financially strapped National Health Insurance system needed to be reformed to make it more cost-effective, Yaung said that the goal could not be achieved if premiums were maintained at current levels.

“Government subsidies have not only stayed high in the past decade, they have gone up markedly for senior citizens because Taiwan’s elderly population has grown by 30 percent,” Yuang said. “The cost of caring for the elderly is three times higher than for younger people.”

He also pointed to premium reductions or exemptions for low-­income or slightly above low-­income households that affect 2.41 million people, or one-tenth of Taiwan’s population.

Under such circumstances, Yaung said, it was only natural that higher income earners pay a little more to help the disadvantaged based on the health insurance system’s fundamental concept of having those with the means assist those who are less well off.

Chu Tong-kuang (曲同光), a deputy convener of a DOH task force on insurance premiums, said the DOH intended to increase the income ceiling (NT$131,700) on which premiums are calculated, as early as the coming week.

The existing ceiling is 7.62 times higher than the minimum income basis, NT$17,280, on which premiums are calculated, and the DOH would like to increase the cap to 10 or 15 times the minimum.

If a factor of 15 is adopted, the new ceiling would be set at around NT$260,000 per month and would increase monthly premium revenues by about NT$1 billion. Moving the income ceiling higher would affect between 80,000 and 90,000 people, Chu said.

Among those affected would be doctors, accountants, lawyers and business executives, he said. The plan to raise the ceiling could be implemented at any time and would not require legislative approval.

The Democratic Progressice Party has also urged the DOH to recover premiums that Taipei and Kaohsiung cities owe the Bureau of National Health Insurance to bridge the system’s shortfall.

In response, Yaung said that recovering the money would not help the system financially because money had already been borrowed from local banks to cover the amounts owed, but he pledged that the money would be collected nonetheless.

Taipei owes approximately NT$36.7 billion and Kaohsiung owes about NT$18.7 billion in premium contributions they were supposed to make on behalf of people working but not residing in their cities.

The two municipalities argued that they were only liable to make premium payments on behalf of city residents and took the case to court, but the courts eventually rejected their argument and ordered them to pay the premiums due.

Taipei has dragged its feet in responding to the court order.

Minister of Justice Wang ­Ching-feng (王清峰) said arrangements have already been worked out with the two cities to repay the balance owed. Taipei and Kaohsiung have agreed to repay what they owe over eight years and six years, respectively.
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