There appears to be a NT$900 million (US$30.36 million) shortfall between the expected and the actual collection of the National Health Insurance (NHI) supplementary premium, the extra premium imposed by the second-generation NHI system, for January, the first month the new system has been implemented, according to the latest data provided by the Bureau of National Health Insurance.
About NT$600 million has been collected so far, which is only 40 percent of the NT$1.5 billion that was expected to be generated, the bureau said on Friday.
The deadline for paying the supplementary premium was Thursday, but since there was a 15-day extension, the final deadline will not arrive until March 15, so the amount collected so far was not final, Bureau of National Health Insurance Director-General Huang San-kuei (黃三桂) said.
According to the bureau’s estimates, it will collect between NT$18 billion and NT$20 billion in supplementary premiums this year.
Huang said the shortfall might have occurred because many companies handed out year-end bonuses last month due to a later-than-usual Lunar New Year this year, and some corporations tend to wait until the last day, with factors such as cash flow and capital management in mind.
The bureau said that the supplementary premium required from stock dividends is paid in June, July and August, the three months in which most of the companies pay the dividends, so those contributions would not be reflected in the monthly supplementary premium collection.
The statistics show that retired civil servants, military personnel and public school teachers are among the major contributors to the supplementary premium, Huang said, and other major sources includes contributions by employers, bonuses, moonlighting and rent.
The new premium-calculating system of the second-generation NHI went into effect on Jan. 1, requiring both regular and supplementary premiums, with the latter being imposed on the non-payroll income of the insured.
Meanwhile, the bureau said that patients with chronic illnesses, and those who have only mild symptoms who visit the emergency room, might be subject to benefit cancellation and increased fees respectively, to relieve the burden on the NHI and maintain the quality of emergency-room care.
According to the bureau’s data, about 4 million patients with chronic illnesses currently benefit from a policy implemented in 1990 that exempts them from paying for their medications in full. However, the bureau said that it would propose canceling the subsidy in the next meeting.
“The partial exemption policy has resulted in the abuse of the medical benefits by some patients, and we undoubtedly want a fairer medical environment where insurers benefit according to their contributions to some extent. We would also like [people] to be more moderate in using the limited NHI resources,” said Lin Are-ming (林阿明), chief of the bureau’s medical affairs division.
The bureau said an estimated 94 percent, or 3.76 million, of the patients with chronic illnesses would be affected by this decision, because they would have to pay between NT$20 and NT$200 more each visit.
Those who visit the emergency room with fourth or fifth triage-level symptoms (with the first being the most urgent), which include diarrhea, allergies and colds, will also be liable for higher charges, the agency said.
“There are about 1 million ER patients of a fourth or fifth level of triage [annually], and they have caused unnecessary crowding in the medical institutes,” Lin said.
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