Lifting medical center cap would cripple NHI: group

QUALITY, NOT QUANTITY::The DOH’s move to lift the restrictions was made unilaterally, would bleed the NHI dry and degrade the quality of healthcare, critics said

By Alison Hsiao  /  Staff reporter

Tue, May 14, 2013 - Page 3

The Department of Health’s (DOH) proposal to lift the cap on the number of medical centers that can be established would hollow out the National Health Insurance (NHI), the National Health Insurance Civic Surveillance Alliance said yesterday at a press conference.

The department announced on Wednesday last week that not only would the cap be lifted, the method for calculating medical center evaluation scores would also be relaxed.

However, the move was suddenly suspended four days later, with the department saying on Sunday that the legislature’s Social Welfare and Environmental Hygiene Committee had required it to provide relevant supporting measures within three months before it could enact the policy.

Despite the delay, the department’s move to ease regulations and its announcing them without holding any prior public discussion were criticized by the alliance.

“No impact assessment was carried before the announcement was made, so it is no wonder that the supporting measures were nowhere to be seen,” alliance convener Huang Sue-ying (黃淑英) said. “How can the government make changes to the number of medical centers without first discussing the issue with the public? The department has failed to fulfil its duties.”

The proposed policy is “more horrifying than corruption and more terrifying than the squandering of funds,” the alliance said.

Huang added that removing the cap would degrade the quality of community hospitals whose healthcare workers and resources would be absorbed by centers, leaving only two kinds of medical providers in the system: small clinics and massive medical centers.

Alliance spokesperson Eva Teng (滕西華) put the matter in terms of the extra expenditure it would impose on the NHI.

“The outpatient and inpatient services offered by the 22 existing NHI-contracted medical centers eat up almost half — 42.86 percent — of the overall hospital budget and 27.81 percent of the NHI’s total budget. If the seven regional teaching hospitals that are rumored to become medical centers really were to upgrade, their inpatient service costs alone would increase by NT$13.2 billion [US$443.2 million], in addition to the increased costs of outpatient services,” Teng said.

The co-payments made by patients would also increase by NT$120, Teng added.

Wu Yu-chin (吳玉琴), Foundation for the Welfare of the Elderly secretary-general and a member of the legislative committee, said at the press conference that she was surprised that the government did not seek the committee’s opinion prior to announcing the proposal.

“The committee is in charge of reviewing NHI expenditures; if regulation changes are going to be made, the department should notify and discuss the matter with the committee in advance,” Wu said.

What is more alarming is that while the government has been advocating the establishment of community healthcare networks encompassing a family physician system and a well-planned referral system, boosting the number of medical centers would be detrimental to building such networks, Wu said.

“The issue would remain open to discussion if the medical centers were to be established in medical resource-deprived regions, but that does not seem to be the case,” Wu said.

Teng said that the seven hospitals the alliance thinks will be upgraded if the cap is relaxed are all located outside of the 14 counties and cities that currently do not have any medical centers.