The National Health Insurance Administration (NHIA) is considering how to adjust the National Health Insurance (NHI) supplementary premium rate to address the increasing NHI global budget, NHIA Director-General Shih Chung-liang (石崇良) said yesterday.
As the NHI system has been running for nearly 30 years, it is facing multiple challenges, including a rapidly aging society, a rise in the number of people with chronic illnesses, a shrinking working population due to a low birthrate and uneven distribution of medical resources, Shih said at a forum organized by the Taipei Doctors’ Union in Taipei.
He was invited to the forum to speak about the state of the NHI system and potential reforms.
Photo: Chiu Chih-jou, Taipei Times
While the NHI global budget for next year has not been decided, a high estimate is that it would increase by about NT$53.1 billion (US$1.65 billion), or 6.06 percent, from this year, he said.
With additional government funding of about NT$1.11 billion, a special fund of NT$5 billion for new cancer drugs and NT$2 billion for medicines for rare diseases, the growth rate would be about 8.13 percent, the highest on record, he said.
However, the NHI premium rate has only been increased twice in nearly three decades — from 4.25 percent to 4.55 percent and to 5.17 percent, he said, adding that it is unbelievable that the system has lasted until now.
Its financial structure should be adjusted to meet the expanding NHI global budget, he said.
Seventy-five percent of the NHI budget comes from general premium payments by insured people, mostly salaried workers, about 9 percent is from supplementary premiums, and the rest is from the government and special funds, he said.
The supplementary premium is imposed on employers and insured people who earn more than NT$20,000 per year from six non-salary sources: stock dividends, interest, second jobs, rent, professional practices and bonuses in excess of four times their monthly salary, he said.
The agency is considering decoupling the general premium and the supplementary premium rates, and possibly even separating the six non-salary sources, setting independent rates for each of them, as well as adding new non-salary sources for collecting the supplementary premium, he said.
The growth of family income does not necessarily coincide with the nation’s overall economic growth, so considering generational equity, the agency does not want to put too much burden on salaried workers by raising the general premium rate too fast, Shih said.
The NHI had a surplus for the past two years, but that was not due to the general premium — which was 5.17 percent — but rather from supplementary premiums collected from stock dividends, he added.
The government should share more of the burden by expanding the NHI budget sources, such as no longer limiting it to tobacco health and welfare surcharges, and the annual government budget, he said.
It could collect a percentage of other taxes, Shih said.
However, the ideas need to be discussed further and laws would have to be amended, he added.
Additional reporting by CNA
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