Fri, Dec 10, 2010 page2

• ANALYSIS: Critics speak out on second-generation health insurance

  • By Shelley Huang / Staff Reporter
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  One topic that has animated politicians and representatives from the medical and pharmaceutical industries in recent weeks has been the controversy surrounding the -second-generation healthcare plan.

  While some — especially the Department of Health (DOH) — have hailed it as the solution to the financial problems that have long plagued the National Health Insurance (NHI) Fund, whose deficit is growing, despite government efforts to persuade the public that the proposed plan is “fairer” than its predecessor, many lawmakers and civic organizations are not convinced.

  The most significant difference between the current NHI system and the one that would emerge from the proposed amendments to the National Health Insurance Act (全民健康保險法) is that the latter involves a new scheme for calculating premiums based on total household income rather than an individual’s salary, as is the case under the existing scheme.

  The new plan would also do away with the requirement that a patient cover the difference when the price of an expensive drug is higher than the amount covered by the NHI. The measure is intended to benefit patients who require drugs that otherwise would receive little attention from pharmaceutical companies by creating incentives for those companies to invest more in the development of drugs that otherwise bring in little profit.

  “As long as the health authorities establish a comprehensive set of rules to help facilitate the smooth implementation of the new plan, we see it as a welcome change,” Taipei Pharmacist Association president Lien Jui-meng (連瑞猛) said.

  “Drugs that are covered by the NHI are more likely to remain reasonably priced [than drugs that are not covered], because the NHI has a committee of experts who will monitor the price of medication to prevent it from wasting the NHI system’s resources,” he said.

  Lien said there was nevertheless a potential for improper management and monitoring of drug prices on the part of the NHI committee.

  As the general public is for the most part unclear on what types of drugs to choose and whether it is necessary to pay for expensive drugs that are not covered by the NHI, patients who are not well informed by their doctors may be at a disadvantage, he said.

  Eva Teng (滕西華), spokesperson for the Consumers’ Foundation and the National Health Insurance Civil Surveillance Alliance, also expressed concern over the implementation of the plan.

  While patients will have to choose between drugs that are covered by the NHI and those that are not covered, the options will not be as clear cut when it comes to other medical products, some of which will remain only partly covered by the NHI, she said.

  “Patients might be persuaded by doctors and medical product makers to choose new, expensive options that are only partially covered by the NHI, but if they are not able to make informed decisions because of a dearth of medical regulations, they could be at a disadvantage,” she said.

  Teng said it was crucial that a set of rules to govern the implementation of the new system be implemented so that patients who are not fully knowledgeable about the possible benefits, costs and side effects of new drugs do not pay extra money for products that in the end will not be worth the investment.

  Patients who need special medical products such as coronary stents, artificial joints and intraocular lenses, for example, will find it difficult to avoid purchasing them even if they are not covered by the NHI, Teng said, adding that such people were at risk of becoming the principal victims of the new plan.

  “Without clear guidelines and transparent information, patients facing the choice between products that are fully covered by the NHI and those that are only partly covered will be at a loss as to how to make a medical decision,” she said.

  Andrew Lee (李應紹), an attending cardiologist at Jen Ai Hospital, said some doctors engage in unscrupulous practices at the cost of the well-being of patients by recommending medical procedures or treatments with higher -reimbursement rates and profit.

  “For example, a doctor who recommends regular exercise, a healthy diet and quitting smoking to a patient with heart disease does not receive reimbursement from the NHI for that advice, but a doctor who recommends expensive surgical procedures such as implanting coronary stents — especially drug-coated stents — or bypass surgery will be reimbursed by the NHI,” he said.

  Coronary stenting is a surgical procedure used to treat patients with heart disease or at high risk of a heart attack that involves the insertion of a tiny mesh tube into a narrowed coronary artery to keep the artery open. Patients can choose between regular stents that are completely covered by the NHI, or drug-coated stents, which are allegedly more effective, but for which patients must cover the cost difference.

  Lee said a lot of medical resources were being wasted because “patients may be undergoing expensive medical treatment and procedures they do not really need, but were prescribed or recommended by a doctor eager to earn extra money.”

  Despite the controversy surrounding the new plan, everybody agrees that whether the government manages to keep the NHI system — which is about NT$30 billion (US$1 billion) in deficit — will be contingent on what becomes of the second-generation health plan.
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