The cost growth rate of ventilators used by long-term patients has decelerated in the past five years due to effective cost control measures, the Bureau of National Health Insurance (NHI) said.
The bureau said that between 2008 and last year, annual spending on ventilator-dependent patients was between NT$26.1 billion (US$878 million) and NT$27 billion, with a cost growth rate of 1 percent, lower than total healthcare spending growth of 4.25 percent.
Through repeated revisions of the payment system, the effective management of patients’ inter-hospital moves, supervision of the quality of nursing care and check-ups by specialist physicians, the annual cost growth rate has been reduced from 20 percent to 1 percent, the bureau said.
Alongside this large reduction, an increasing number of patients are being weened off ventilators, from 31 percent to 45 percent, and the mortality rate has decreased from 56 percent to 45 percent.
The second-generation NHI is aiming to streamline use of medical resources, and controlling the cost of ventilators used by long-term users is a crucial part of acheiving this goal which involves cooperation on the part of the hospitals.
However, public awareness of hospices is another aspect that needs to be developed and it is to this end that an amendment to the Hospice Palliative Care Act (安寧緩和醫療條例) was made to lower the threshold for withdrawing life-sustaining medical treatment for terminally ill patients, the bureau said.
Under the amended act, a terminal diagnosis confirmed by two specialist physicians and a letter of intent signed by the patient are the only two requirements needed for the withholding of cardiopulmonary resuscitation performance and the removal of life-support.
If no such letter or other advanced directives were signed or written and the patient lacks decisionmaking capacity, only one immediate family member’s consent is needed for discontinuing life-sustaining treatment.
In either case, the hospital’s medical ethics committee, whose approval was required before, is excluded from the decisionmaking process.
The bureau said that the increasing number of people who registered for the hospice palliative treatment, from 22,548 in 2008 to the current 144,986, shows that there has increased in public awareness.
According to the NHI database, most long-term ventilator-dependent patients were in intensive-care when they first received ventilator tubes. However, they became ventilator-dependent after receiving treatment.
The bureau said that if patients, their families and the intensive care unit staff can hold a proper discussion about the matter beforehand, there is a possibility the ventilator usage rate can decrease significantly.
The bureau said it started to provide consultation services in February last year to such patients and families, aiming to lessen both the financial burden generated by futile medical care and the drawn-out suffering endured by bedridden patients.