Wed, Oct 13, 2004 page2

• Clinics call fees unfair

  • By Joy Su / STAFF REPORTER
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  Despite protests by health-care workers at the Legislature and the Control Yuan yesterday morning, Premier Yu Shyi-kun vowed that health insurance premiums would not increase before his term ends in February.

  Demonstrators representing more than 300 clinics and hospitals complained of financial difficulties from what they called unfair insurance regulations.

  Protesters called for changes in the Bureau of National Health Insurance's (BNHI) fixed-budget policy, which they said resulted in reimbursements at rates that made smaller hospitals lose money. At the beginning of this year, community hospitals were reimbursed at a rate of NT$0.72 per point for outpatient services. Points are accorded hospitals in accordance with medical expenses and services provided and are used to calculate reimbursement. Similar figures for larger medical research centers were reimbursed at NT$0.95 per point in the same period.

  The protesters also took issue with a regulation under the Hospital Excellence Plan (醫院卓越 計畫), which rewards hospitals that treat outpatients and inpatients at a ratio of 45 to 55. While hospitals able to meet the 45:55 ratio are rewarded with extra funding under the plan, smaller clinics, lacking resources to accommodate inpatient services, are often unable to meet such standards.

  Democratic Progressive Party legislator Lin Chin-hsing (林進興), formerly a doctor, yesterday joined in the protests and called on the Department of Health to guarantee that smaller clinics and hospitals be refunded at least NT$0.85 for every dollar they apply for. He said reimbursement rates of under NT$0.80 would put hospitals in debt.

  Health authorities yesterday refrained from making promises, conceding only that the nation's universal health insurance program was indeed in financial difficulty.

  Despite the premier's vow not to increase insurance premiums for the time being, health authorities yesterday said that solutions for the current financial difficulties would most likely come in the form of premium and co-payment increases, or else restrictions on the range of medical services covered by health insurance.

  "Under current regulations, the National Health Insurance sys-tem's income is increasing at a rate of 4 percent each year. How-ever, medical expenses are increasing at a rate of 6 percent each year," Department of Health Director-general Chen Chien-jen (陳建仁) said yesterday, pointing to the aging population as one reason for increased medical expenses.

  Chen also explained that if the insurance system continues to operate as it currently does, funds will soon run low, with reserve funds hitting just NT$300 million by the year's end.

  The BNHI is legally bound to reserve NT$29 billion in funds as a safety measure to cover expenses when the insurance's annual income is insufficient.

  However, Chen added that a final decision will be made after a citizens' forum is held on the issue.

  He also responded to protesters' complaints by agreeing that the 45:55 ratio was inappropriate for community clinics, although he called it workable for larger hospitals.

  Chen said that the health department is negotiating with representatives of several community clinics, and said he anticipated a decision on a new ratio or formula by Friday.

  Premium increases are not the only possible solution to the insurance system's financial difficulties, National Health Insurance Task Force chairperson Wang Yi-ren (王怡人) said.

  "For example, we could increase taxes imposed on alcohol and cigarettes to boost insurance funds. The medical services covered by insurance can also be adjusted," Wang said.
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