Deteriorating doctor-patient relations and overuse of medical care under a fee-for-service (FFS) payment system can be improved and curbed by consolidating the family physicians system with a capitation payment system, which is now being undertaken as a pilot project overseen by the National Health Insurance Administration, a group of physicians has said.
As the ideas of patient-centered, local healthcare and community medicine flourish and come to be seen as an effective means to achieve better patient outcomes and reduce costs, Taiwan is moving in that direction by phasing in a capitation payment system to encourage preventive and value-based healthcare.
A plan to integrate local clinics and hospitals in a community to form a community healthcare group has been in place since 2003, but under the FFS payment system, time is usually restricted for each patient and the proposed community-based family physicians system has been greatly discouraged.
Scheduled in 2011 in the National Health Insurance Act (全民健康保險法) to be drafted by the insurer to “promote preventive medicine, implement the referral system and improve the quality of medicine and treatment,” the family physicians system with benefits paid out on a per-person basis is an alternative to the FFS payment in a global budget system, and has been implemented by several groups in a three-year pilot project that started last year.
National Taiwan University Hospital (NTUH) Jinshan Branch physician Shih Chih-yuan (施至遠), one of the project participants, began his presentation at a conference hosted by the Formosan Medical Association by telling a story about an elderly woman who was hospitalized for gastric bleeding.
“We later found out that she had been taking a double dose of both aspirin and Lasix because she came to our hospital, but also visited another local clinic, and we both prescribed the same kinds of drugs for her [chronic] illness,” he said.
Patient-centered and whole-person healthcare supported by a family physicians system, with good health education, could have saved the woman her suffering. And with better doctor-patient relations, there has also been an uptick in patient visits at the regional hospital, Shih said.
However, the current system is not without its problems, physician Yu Yi-cheng (余儀呈) said, saying the payment system being tested focuses on saving costs, rather than the value of health and disease-prevention achieved.