Challenging how the nation’s national health insurance (NHI) system allocates funds has long been considered taboo because of the interests involved, but the issue must now be faced to ensure sustainability, Control Yuan member Huang Huang-hsiung (黃煌雄) said.
Huang, whose main focus in the past was Taiwan’s military budget, said he only began concentrating on the national health insurance system in 2009 and found considerable waste and misallocation of funds that could undermine healthcare in Taiwan.
Highlighting the problem, Huang said, was the purchase of kidney dialysis equipment and respirators, which currently costs an average of NT$60 billion (US$202.92 million) annually.
Over a decade, such spending would total NT$600 billion and surpass the 10-year NT$500 billion military budget for second-generation fighter jets, Huang said on Friday as he launched his book on the country’s national health insurance system.
Huang’s book is based on visits to 200 hospitals and clinics and 3,000 interviews with academics, medical experts, hospital managers and civic groups he conducted in 2009 with the help of fellow Control Yuan members Shen Mei-chen (沈美真) and Liu -Hsing-shan (劉興善).
Huang said that if he had noticed the trend toward rising expenditure on kidney dialysis equipment and respirators 10 years ago, he would not have let them expand without limit.
Taiwan’s national health insurance system underwent a second-generation reform last year to strengthen its revenue base in the face of a widening gap between expenditures and revenues.
However, Huang says in his book that a third-generation reform is necessary to restructure expenses, reduce the waste of -medical -resources, including excessive spending on equipment, and protect local community hospitals.
Other recommendations include restructuring four major hospital departments — gynecology, pediatrics, surgery and emergency rooms.
Chiang Tung-liang (江東亮), a professor with National Taiwan University’s College of Public Health, said last year’s second-generation reform was still unable to solve the system’s financial problems, adding that the third--generation reform proposed in Huang’s book would be more effective because it seeks to distribute medical resources fairly.
Taipei Veterans’ General Hospital Superintendent Lin Fang-yue (林芳郁) said the incentives provided by Taiwan’s health insurance system have caused the medical system to develop abnormally.
At present, between one quarter and one third of Taiwan’s 40,000 doctors are in the cosmetic surgery sector, and with the health insurance system providing an “all you can eat” medical buffet, “it is difficult to ask people not to waste resources,” said Lin, a former health minister.
These faults should be corrected, or else the health insurance system that Taiwan prides itself on as one of the world’s best will be unsustainable, Lin said.