Wed, Jul 01, 2020 page8

• Clearing obstacles to NHI reform

  • By Hong Chi-chang 洪奇昌
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  The National Health Insurance Administration (NHIA) on June 9 announced that it had set maximum out-of-pocket copayments for eight common types of medical devices, which would take effect on Aug. 1.

  The policy was met with fierce criticism, but less than one week later, the Ministry of Health and Welfare in a June 13 meeting reached three preliminary agreements with parties in the medical community that quelled the opposition.

  A minor dispute arose from someone livestreaming the event after a last-minute decision to have a closed-door session, but ministry staff deserve praise for getting a transcript to all participants before dawn the next day.

  Minister of Health and Welfare Chen Shih-chung (陳時中) directed what turned into a model rational discussion with representatives of the public, a good debut certain to pay dividends.

  A review of the transcript and discussion with friends in the medical community showed that the major points fall under two main complaints:

  First, while the NHIA has said that the policy’s impact would be limited, because it would only affect about 5 percent of devices, medical professionals said the items are frequently used, so price caps would affect their income.

  Second, medical professionals said that price caps might block higher quality, costlier devices from entering the market, and the policy might eventually extend to devices not covered by the National Health Insurance (NHI) system. The policy drew such a strong backlash because it affected their morale.

  The meeting’s three agreements — postponing the policy, referencing international pricing for unreasonably priced devices and increasing pricing transparency — represent an adequate response to the controversy and resolve the two main complaints.

  The proposal to implement an across-the-board price cap immediately would not remedy the problem of information asymmetry between doctors and patients.

  The ministry’s willingness to revise the policy by referencing international pricing, refining the device categories and examining price transparency is likely to make decisions on price zones more objective and flexible.

  Postponing the policy would not have a negative effect on the government or private individuals. More time permits the ministry and hospitals to develop a pricing strategy that would satisfy both sides, and allows the public to better understand their treatment rights and obligations.

  The meeting probably allayed the fears of most people, including many legislators, who panicked when seeing the limited list of medical devices, thinking that the government planned to set price caps for all copayment devices.

  The public should be aware that average household medical expenses are rising.

  Medical expenses accounted for 10.37 percent of the average Taiwanese household’s expenditures in 1995, the year that the NHI program was launched, but 15.85 percent in 2018, surpassing for the first time expenditures on food, tobacco and alcohol and coming in second only to housing.

  The average medical expenditure per household rose from about NT$72,000 in 1995 to NT$130,000 in 2018, Directorate-General of Budget, Accounting and Statistics data showed.

  Over the past 23 years, medical expenses have increased more than 2 percent per year, exceeding Taiwan’s inflation rate. Medical expenses have shown the greatest growth in scope and number, without any sign of slowing down.

  With population aging likely to accelerate, medical expenses are expected to account for nearly 20 percent of household expenditures by 2030, becoming an onerous financial burden, so careful consideration should be given to healthcare services that have a big price range.

  Taiwan has managed to achieve impressive NHI coverage by relying on medical services that are cheaper than those in most nations.

  Its successful response to the COVID-19 outbreak can also be attributed to the trust that the public has in Taiwanese medical professionals.

  The NHI system must make ends meet. The public should cherish its achievements, while joining to protect and maintain it.

  There is a long way to go before most people back the policy and before all obstacles to NHI reform are cleared. The public, medical professionals and the government need to keep communication open and see things from the other’s perspective.

  The pride of Taiwan’s democracy can be found in the willingness of Taiwanese to build a consensus through negotiation and compromises.

  Hong Chi-chang, a physician, is the chairman of the Taiwan Economy and Industry Association.

  Translated by Chang Ho-ming

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