《TAIPEI TIMES》 Experts urge more NHI out-of-pocket fees

By Dennis Xie / Staff writer, with CNA

The National Health Insurance （NHI） system should include more out-of-pocket items and raise the fees for people who benefit more from it, experts said yesterday, citing a 95 percent increase in medical expenses covered by the government from 2000 to 2017.

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The NHI system is expected to face a deficit of NT$77.1 billion （US$2.66 billion） next year, with reserve funds that could only cover one month of expenses, Ministry of Health and Welfare statistics showed.

From 2000 to 2017, although 0.3 percent fewer people visited hospitals, the average number of hospital visits per person per year increased 14 percent from 12 to 14, and medical expenses per insured person increased from NT$8,422 to NT$16,496, a 95 percent hike, Shinkong Wu Ho-su Memorial Hospital vice superintendent Hung Tzu-jen （洪子仁） said at a conference in Taipei on NHI reform.

Ninety percent of people would visit a general practitioner if they have minor cold symptoms, while 85 percent would visit a hospital only if they experience more severe symptoms, Hung said, adding that the data suggest that most people try to avoid wasting medical resources.

People with chronic but stable conditions visit hospitals frequently, despite a visit to a general practitioner being sufficient, Hung said, adding that this burdens the system.

“Use more, pay more; use less, pay less; and pay nothing for urgent treatment” should be the direction of NHI reform, he said.

People should cover part of the costs for high-priced imaging examinations, unless they are in a critical condition, he said, adding that deductibles for medications should be capped at NT$500, instead of NT$200, as it is today

NHI Medical Administration section director Lee Chun-fu （李純馥） said that although raising premiums and deductibles would likely provoke strong public opposition, the steps would be necessary.

Finding consensus is difficult, because most people prioritize their own needs over the needs of others, Lee said, adding that copayments for prescribed chronic disease drugs were not a viable step, as some people might start taking medication irregularly.

Taiwan Medical Alliance for Labor Justice and Patient Safety representative Chien Li-chien （簡立建） said that premiums should only be raised for people who frequently visit hospitals, instead of burdening everybody.

People who use fewer public medical resources should pay less in premiums, or even be refunded, so that the NHI system can operate on a user-pay model, Chien said.

Too many resources are wasted on unnecessary medical care, he said, citing a great number of bed-ridden patients in a vegetative state who get frequently transferred between nursing homes, hospitals, and emergency rooms.

A great portion of the NHI budget is used to sustain the lives of these people, even though they have been unconscious for many years, Chien said, adding that these patients should be excluded from the system.

新聞來源：TAIPEI TIMES