The Ministry of Health and Welfare is overstepping its boundaries when it constantly bypasses due process and overlooks the negotiated conclusions reached by the National Health Insurance Committee (NHIC), the National Health Insurance Civic Surveillance Alliance said yesterday.
On the eve of the committee starting a new round of two-day negotiations regarding the growth rate and allocation of next year’s National Health Insurance (NHI) global budget — nearly NT$600 billion (US$20.3 billion) — at the end of this week, the alliance held a press conference to accuse the ministry of abuse of power and dereliction of duty, which allegedly have made it the main violator of the agreements reached in past global budget negotiations in the NHIC (formerly the NHI Supervisory Commission and the NHI Medical Expenditure Negotiation Committee, before their merger).
The ministry earlier announced a growth rate for this year’s global budget that was higher than the rate agreed by the premium payer representatives in the committee, according to the alliance, which added that the decision was biased toward medical service providers.
The decision to have rabies vaccines covered by NHI by January next year, irrespective of the opposition to this measure voiced by the NHI Drug-Dispensing Items and Fee Schedule Joint Establishment Meeting, was also a violation of procedural protocol, the group said.
“The coverage of vaccines is a violation of the NHI Act (全民健康保險法),” said Huang Sue-ying (黃淑英), convener of the alliance. “However, as the rabies vaccine can be likened to a treatment, we are not really against them being covered. What we’re really against is the ministry overriding the meeting’s decision without attempting further discussions.”
Adding to these interferences with the global budget caused by the authority’s unilaterally initiated policies, Huang said, is the ministry’s decision to grant the same amount of medical payments received by medical centers to regional teaching hospitals, given that they have achieved the “quality” of medical centers according to a hospital assessment.
The move has in substance lifted the cap on the number of medical centers, which is exactly what the authority has decided against just last week, the alliance said.
“As the task and responsibility of reviewing premium rates, the scope of benefits and the total amount of medical payments lie with the NHIC, it is not up to the ministry to have the final say in the matter,” alliance spokeswoman Eva Teng (滕西華) added.
The three policies — a higher global budget growth rate, rabies vaccine coverage and expansion of medical service payments — have not only contravened laws, the group said, but have also added a total of about NT$15 billion to the denominator of the future global budget growth rate, which will result in an increase in co-payments costs because the premium rate, and thereby total premium revenue, remain unchanged.
On the ministry’s alleged dereliction, Teng said the plan to complete the phasing in of diagnosis-related groups over a period of five years has since its introduction in 2010 been thwarted by hospitals and come to a halt.
Numerous pilot projects, some of which have been ongoing for 10 years, have failed to be terminated, as they would if proven ineffective, or to be included in the regular fee schedule, as they would if proven beneficial for all.
There has also been an annual budget (NT$2.5 billion) planned specifically for hospital care fees, Foundation for the Welfare of the Elderly secretary-general Wu Yu-chin (吳玉琴) said, “and the money is supposed to be ring-fenced for the training of nurses and their salary increases.”
However, a supervisory mechanism overseeing fee distribution has been lacking, Wu said.
“In this way the authority is allowing the money to be stashed in hospitals’ private accounts for their arbitrary use,” Wu added.