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進入《TAIPEI TIMES》 NHIA boss targets wasted medical resources
National Health Insurance Administration Director-General Lee Po-chang speaks during an interview in Taipei on Oct. 12. Photo: Fang Pin-chao, Taipei Times
There is an urgent need to reduce waste of medical resources to tackle the National Health Insurance’s astronomical NT$26 billion （US$839.36 million） deficit, National Health Insurance Administration （NHIA） Director-General Lee Po-chang said in an interview with ‘Liberty Times’ （sister newspaper of the ‘Taipei Times’） staff reporters Jennifer Huang and Lin Hui-chin, adding that more efficient medical testing and distribution of medicine would allow for higher-quality medical services
Liberty Times （LT）: The NHIA has required large hospitals to better classify patient needs to reduce emergency-room visits by 2 percent and free up hospital beds. How successful has the policy been?
Lee Po-chang （李伯璋）: Statistics show that from January to August, emergency-room visits have fallen as a percentage of overall cases from 11.7 to 10.7 at medical centers and from 15.4 to 15.1 at regional hospitals from the same period last year. Correspondingly, visits have risen from 10.08 to 10.2 percent at local hospitals and from 63.3 to 63.9 percent at basic clinics, which shows patient classification is improving.
In the two months since the policy went into effect, of the 71 hospitals that needed to reduce emergency-room visits, 38 have reached their goals, while of the 19 medical centers we identified, eight have met the goal.
Classifying patients is not intended to reduce the number of hospital visits or reduce revenue.
However, in there had been criticism that hospitals were working people to death and next year there will be changes to the hospital work environment, such as amendments to the Labor Standards Act （勞動基準法） to cover resident medical staff. All hospitals would realize that they must consider labor costs and quality of medical treatment, which would mean they have to classify the needs of patients and distribution of labor.
LT: What other policies are planned to expand classification of treatment needs?
Lee: Most people prefer to visit medical centers or regional hospitals to see a doctor. The number of local hospitals has fallen from more than 700 to just more than 300.
Hospital administrators have to keep up with the times and look for new opportunities. Work hours at large hospitals have been adjusted as physicians at smaller clinics seek to improve their quality of life and reduce operating hours.
A poll among doctors has shown that from January to August, clinics were open on Saturday for 81.6 percent [of operating hours on a weekday] and 20.1 percent on Sunday.
People cannot choose when they fall ill, so the NHIA and local hospitals have come to an agreement. From next month, local hospitals will keep regular hours on weekends, which will benefit the public by allowing people to see doctors closer to home and provide a great opportunity for local hospitals to transform themselves.
The NHIA will also raise doctors’ fees for weekend visits. Hospitals will get 100 points for every patient seen on a Saturday and 150 points for every patient seen on a Sunday.
Furthermore, younger doctors would have more opportunities to see patients.
However, one challenge is that people tend to have less confidence that medical treatment at local health providers will be effective.
Local hospitals and clinics will work with National Taiwan University, Chang Gung Memorial Hospital and 73 other institutions nationwide to cooperate through a vertical alliance.
Information such as medical histories and tests will be shared between the institutions. People with serious illnesses can be more quickly prioritized for referral to medical centers and the best doctors from the big hospitals can go to local hospitals to see people or perform surgery.
People will definitely see an improvement in treatment when they go to local hospitals.
LT: With doctors’ work hours changing next year to comply with the act, will the National Health Insurance come under more pressure?
Lee: The National Health Insurance fund has about NT$200 billion in reserve and the NHIA will not consider adjusting insurance rates for another three years. The task in front of us is to cut expenditure and minimize waste.
To address often-criticized issues, such as repeat examinations and over-prescription of drugs, the NHIA is promoting a cloud-based data-sharing system for examinations and medical histories.
The system is used by more than 25,063 hospitals and clinics, as well as 60,000 medical personnel. We record a 100 percent use of the system at hospitals, 96 percent at clinics and 90 percent at Chinese medicine clinics and pharmacies.
The system has seen more than 500 million searches for medical information.
We have discovered that the most commonly prescribed repeat medications are those for hypertension, hyperlipidemia of hyperglycemia, schizophrenia and depression, as well as sedatives.
Repeat prescription rates last year were down 50 percent from 2014, saving the NHIA NT$340 million.
In the second half last year, examinations, such as CT scans and blood tests, dropped by 4.8 million, saving the NHIA another NT$1.2 billion.
However, we have also noticed that some people did not report back to the hospital that performed a CT scan or MRI, but had the same examinations done at another hospital.
Such practices have cost the NHIA NT$1.7 billion, so it is mulling the possibility of refusing NHI payouts for hospitals that repeat an examination within one month. Medical payouts should be spent wisely and should not go toward unnecessarily repeated tests.
For example, 250,000 people are diagnosed with shingles each year, but only 60,000 meet NHI standards to receive its antiviral medication.
If the NHIA relaxes its standards, more people would receive the treatment and would not have to wait until they develop nerve pain before they consult a doctor, which would cut down on medical payouts in the long term.
More than 80,000 people are on dialysis, with overall costs potentially reaching NT$60 billion.
As kidney transplants have better results when it comes to extending life, the NHIA will offer greater incentives for doctors to recommend organ transplants instead of dialysis.
Such measures would not only decrease pain for patients, but would also cut expenditure.
LT: The estimated payout for the NHI is to exceed NT$1 trillion soon and it might be inevitable that the fund will go bankrupt. What are your thoughts on “third-generation NHI” research that your predecessors have called for?
Lee: We are fortunate to still have NT$200 billion in reserve, but if annual expenditure continues to rise by nearly 5 percent while funds grow at 4.5 percent, there is, of course, a deficit, which demands reform.
The second-generation NHI program introduced supplementary premiums, which is in essence an increase in premiums.
However, the 2016 decrease of premiums has produced a deficit of nearly NT$10 billion since last year. It is possible the deficit could rise to NT$20 billion this year.
The NHIA will have to face the pressure of imminent bankruptcy if it does not increase the premium rates.
Reforming the NHI is the Ministry of Health and Welfare’s responsibility, as the NHIA is theoretically only a consultant and policy executive.
Changes to premiums based on family income have been discussed. The NHIA’s preliminary understanding of potential changes is that the nation is seeing a net annual decrease in the labor force, with nearly one-quarter of the population not declaring an income.
Add to that the fact that family incomes wax and wane according to the overall economic environment.
Such unforeseeable, or unreported, issues must be overcome if the third-generation NHI is to improve stability and viability in the long term.
Translated by staff writers William Hetherington and Jake Chung
新聞來源：TAIPEI TIMES
