The National Health Insurance Administration (NHIA) on Tuesday said it is considering a policy change to require Taiwanese who reside abroad to pay higher national health insurance (NHI) premiums if they return to Taiwan for healthcare.
Currently, Taiwanese living abroad for six months or more have the option of canceling their NHI payments and resuming coverage upon returning to Taiwan.
The proposed policy would follow past changes to the NHI that have been in response to concerns about abuse of the system and its solvency. In a May 2019 article published by the American Chamber of Commerce in Taiwan, contributing writer Jane Rickards was of the opinion that the system might be two years from bankruptcy due to rising costs and an aging population, unless the premium was raised.
The rate was raised on Jan. 1 last year from 4.69 percent of annual salary to 5.17 percent, the first increase since 2016. Minister of Health and Welfare Chen Shih-chung (陳時中) at the time said that the increase was made out of fears that the system would run out of money by the end of this year.
Rising costs have been exacerbated by people making fraudulent reimbursement claims to the NHI.
NHIA senior official Kao Shih-hao (高世豪) in November 2016 said that fraudulent claims from medical facilities increased from NT$68.22 million (US$2.43 million) in 2013 to NT$83.16 million in 2014, and nearly tripled in 2015. Kao has said that the NHIA had stepped up its investigations the year before amid an increase in collusion between healthcare practitioners and the public, using false medical records to declare payments or make insurance claims.
In February 2020, eight members of a family were charged with defrauding the NHI system. The family allegedly filed claims with private insurance companies for sums ranging from NT$5,000 to NT$10,000 per day of hospitalization for mental illnesses, totaling NT$55.7 million during an 11-year span, and obtained NT$9.38 million from the NHI to cover “medical expenses,” the prosecutor on the case said.
There have also been cases of Taiwanese colluding with medical institutions abroad for deceitful claims in Taiwan. In May 2020, the NHIA said it had revised rules on overseas reimbursement claims after it discovered women who falsely reported needing special procedures in the US due to childbirth complications.
Taiwan’s national health insurance system and its quality healthcare are admired abroad. A feature story in the online publication Vox on Jan. 13, 2020, referred to the system as “hell” for the doctor, but “heaven” for the patient. It cited a former health official as saying that Taiwan’s system was the realization of “the principle of health [as a] human right.”
However, the healthcare system must be protected or it could be lost. The reason the article said that the system is hell for doctors is that it is overburdened, and staff and resources are stretched thin. Politicians are reluctant to raise the NHI premium, which could affect their party’s popularity at election time, but it must be high enough to make the system sustainable. Taiwanese who want to live abroad while returning for healthcare — especially for those in the US, where healthcare is costly — must be required to continue paying premiums just as those living in Taiwan do. Reimbursement fraud must also be deterred by severe punishment.
Canada also has a universal healthcare system, but it does not cover dental expenses, which is the most common use of the NHI by returning Taiwanese expats. Most Canadians who live abroad for more than six months lose access to their system.
It would be ideal for Taiwan’s world-class healthcare to remain accessible to Taiwanese living abroad. However, premium payments must be required by all, even for those living overseas.
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