Proton therapy for childhood cancers has been included in National Health Insurance (NHI) coverage from the beginning of this year. The policy is expected to benefit about 100 children annually, the National Health Insurance Administration (NHIA) said yesterday.
With the addition of proton therapy for treating cancers in children, the NHI payment points for medical providers are tiered into three levels according to absorbed doses, NHIA Director-General Chen Lian-yu (陳亮妤) said.
They are set at 676,000 points for low-dose, 1.03 million points for medium-dose and 1.26 million points for high-dose treatments, she said.
Photo: CNA
Clinical evidence shows that precise and concentrated high-energy proton beams can target and destroy cancer cells, while minimizing damage to surrounding healthy tissue and organs, Taiwan Society for Therapeutic Radiology and Oncology chairman Chao Hsing-lung (趙興隆) said.
Compared with conventional radiotherapy, proton therapy not only has the advantages of lowering side effects, but also reduces the risk of secondary cancers, and is considered safer, while offering better long-term prognosis for children with cancer, he said.
While NHI fully covers proton therapy for treating children with cancer, it is limited to treatment indications that are empirically proven to be safe and effective, so not all childhood cancers are eligible, NHIA Medical Affairs Division head Huang Pei-shan (黃珮珊) said.
The agency estimated that about 100 children with cancer would benefit from the policy each year, supported by about NT$105 million (US$3.32 million) NHI funding per year, Huang said.
Two other NHI payment policies also took effect this month, including increased payment for emergency major trauma surgery or treatment, and a hyperlipidemia medical payment improvement program, the NHIA said.
To enhance hospitals’ emergency major trauma treatment capacity and resilience, the agency is offering increased NHI payment points as incentives for prompt treatment, Chen said.
Payment points are increased by 100 percent for medical services — including certain radiation examinations, procedures, surgeries and anesthesia — performed within two hours of a patient’s arrival at an emergency room, and increased by 60 percent if performed between two and four hours after their arrival, she said.
The incentive payment would first be distributed to frontline medical workers, to reward their emergency and critical care efforts, Formosa Association for the Surgery of Trauma secretary-general Kuo Ling-wei (郭令偉) said.
The hyperlipidemia medical payment improvement program was developed with nine local medical associations, and is a part of the NHIA’s “pay for performance” initiative for improving treatment quality, Chen said.
Based on the atherosclerotic cardiovascular disease risk levels and the “consensus on clinical pathway of blood cholesterol management,” the agency is encouraging healthcare centers to provide medical services to people with hyperlipidemia who are at “extremely high” and “very high” risk, she said.
The program offers case enrollment fees between 500 and 2,000 NHI payment points and a referral fee of 1,000 points for receiving treatment and follow-up treatment, she added.
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