The National Health Insurance (NHI) system has been in deficit for four consecutive years. The shortfall is expected to reach NT$67.6 billion (US$2.35 billion) by the end of this year, while the reserve fund would last for less than two months, NHI Committee data showed.
By the end of next year, the deficit is forecast to reach NT$77.1 billion, while the reserve fund would cover less than the statutory minimum of one month.
NHI premium rates should be adjusted based on the judgements of actuaries, not on the notion that lower premiums are simply better. Short-term savings in the long term jeopardize the quality of healthcare and fail to meet the public’s needs.
Above all, the government must beware the following myths.
The first myth is that the government should avoid adjusting premiums, and if they must be changed, only raise them enough to meet the one-month statutory minimum.
This is a malicious idea. If premiums were only increased enough to reach the minimum threshold, there might be less of a public backlash, but premiums would have to be adjusted again in less than two years. By that time, elections would be approaching, so the NHI would no doubt be treated as a pawn on a political chessboard.
However, history shows that any increase in NHI premiums usually leads to the minister of health and welfare having to step down.
This kind of manipulation would have little to no influence on the outcome of an election.
The second myth is that increasing NHI premiums amid the COVID-19 pandemic would not only increase the burden on the public, but also put economic pressure on employers.
It would be strange for members of the NHI Committee to say that premiums should not be increased. The purpose of setting premiums is for the sake of the public’s health, not to save money just for the sake of saving it.
The average person might not understand this, and employers might not want to pay more, but NHI Committee members are duty-bound not to ignore this central concept of the NHI system.
Blindly holding down NHI premiums would have the unwanted effect of making patients pay higher copayments and self-pay items, which would be harder for some people to bear. It would be completely contrary to the idea that the NHI should eliminate financial barriers for the underprivileged.
Although many might sympathize with the public mood, they must also not deny that healthcare has to be paid for somehow.
The third myth is that premium hikes can be kept low by adjusting copayments at the same time.
Increasing copayments means punishing the public. My observations as a physician tell me that it is human nature to be anxious about illness, so even if healthcare and medicine costs increase, the number of people who visit hospitals for treatment would not decrease in the long term.
Even if the government makes punishing adjustments, any effect it might have at the beginning would not last long, and it would definitely end in failure.
When considering whether it is appropriate to increase NHI premiums, the responsible approach would be to refer to the steady increase in NHI spending relative to GDP. If the nation wants to move away from the passive approach that forces the state to make up for the NHI’s losses, it should make improvements to the system, such as by rewarding physicians who promote preventive medicine, so as to improve the public’s health literacy. Such changes would be the right way to achieve real cuts in healthcare expenditures.
Twu Shiing-jer is chairman of the Development Center for Biotechnology and a former director-general of the Department of Health.
Translated by Julian Clegg
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