Health authority seeking to prevent waste of resources

Staff writer, with CNA

Sat, Apr 20, 2013 - Page 4

The national health insurance authority has reinforced measures to prevent the waste of National Health Insurance resources, including setting a goal of reducing the medical utilization rate by 20 percent this year.

The Bureau of National Health Insurance is hoping to reduce the volume of medical utilization by heavy users of outpatient services under the National Health Insurance system by 1.25 million visits this year, bureau division chief Lin Pao-feng (林寶鳳) said yesterday.

She said that if achieved, it would save the government NT$1 billion (US$33.5 million) in health insurance expenses this year.

To accomplish the task, the bureau has narrowed its definition of high medical utilization from 100 outpatient visits per year to 90 visits.

Because of the adjustment, the number of people classed as heavy users of outpatient services increased from 33,000 last year to 59,000 this year, and they have been listed as targets of a government assistance program aimed at guiding heavy users who do not have severe diseases or injuries to use medical services “properly,” the agency said.

Users with severe diseases or injuries are excluded from the category.

Last year, about 33,000 heavy users received government guidance, which succeeded in reducing the medical utilization of each one by 24 percent and lead to a reduction of 950,000 visits by heavy users, the bureau said.

The reduction represented a saving of NT$829 million for the cash-strapped National Health Insurance system, the bureau said.

Lin said a 48-year-old man living in the south visited hospitals and clinics 582 times last year, making him the heaviest user of outpatient services in the country.

The man, who complained of high blood pressure, back pain and mental problems, was one of four people who sought medical services under the National Health Insurance system more than 500 times throughout the year, Lin said.