Since its inception in 1995, the National Health Insurance (NHI) system has been a major help to everyone in Taiwan. Before it was introduced, being diagnosed with chronic diseases such as uremia, for example, could have led a vulnerable family to financial ruin due to the huge medical bills that its treatment requires.
The implementation of the NHI system was a major step forward for society and a boon for the masses.
Several days ago, a report in the media said that the Ministry of Health and Welfare would raise NHI premiums next year, passing on the cost burden to those seeking treatment.
This is the right course of action. It is consistent with the point of view expressed by NHI officials in the past, and with the direction that National Health Insurance Administration (NHIA) Director-General Lee Po-chang (李伯璋) has been taking, to reduce the number of unnecessary visits to hospitals and clinics, and referrals for tests that are simply not needed.
However, following through on this idea, some thought should be given to the size of the one-off payments of individual visits. Currently, there is a ceiling of NT$200 for medication, and each visit for rehabilitation treatments is set at NT$50.
The NHIA has some ideas in this regard that it is thinking of pursuing, such as charging NT$200 for repeat prescriptions even for chronic diseases, and a further NT$300 for any related tests that are needed.
In terms of staving off bankruptcy of the NHI fund, this would provide some help, but it will not be enough, and does not align with the core value of the National Health Insurance Act (全民健康保險法).
The solution has always been there, residing in Article 43 of the act, in the graded medical costs system that the government should have implemented more than 20 years ago.
Under such a system, the flat-rate burden would be replaced with a graded percentage-based system of self-made payments. It is the right way to implement a fair and just system, and would avoid the concerns of people who do not personally use the health service that they are paying insurance premiums for a service they do not benefit from.
This system would only work if it does not leave the disadvantaged, the disabled and the elderly out in the cold, and includes different rules for those who are unable to pay.
There are certain things that can be done to help these groups. The administration could, for example, set lower rates or provide other social assistance for those in need.
In addition, there could be a special fund, paid for from fines levied against hospitals that contravene regulations, which could be used to fund financial assistance for these groups.
The system might even encourage the offending hospitals to clean up their act, and by not adding to the burden on the government and the taxpayer, the NHI system would be closer to the ideal of being more fair and just.
Hsieh Wu-chi is chief supervisor of the Taiwan College of Healthcare Executives.
Translated by Paul Cooper
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