National Health Insurance in Taiwan

1
National Health Insurancein Taiwan

• Bureau of National Health Insurance
• 2007

2
Agenda

• Country Profile
• Overview of the NHI
• Current Status

3
Country Profile
4
Where is Taiwan?
Taiwan

5
Map of Taiwan
Taiwan's most prominent physiographic feature is
its 270-kilometer central mountain range, which
boasts more than 200 peaks with an elevation over
3,000 meters.
6
Profile of Taiwan (2005)

• Population 22.7 million
• Land area 36,190km2 (14,000 mile²)
• Population density 629 per km2
• Population aged over 65 9.7
• GDP per capita US 15,291
• NHE as of GDP 6.16

Sources Ministry of
Interior,Directorate-General of Budget Accounting
and
Statistics,Department of Health
7
Health Indices (2005)

• Crude Birth Rate 9.1 0/00
• Crude Death Rate 6.10/00
• Infant Mortality Rate 5.0 0/00
• Natural Increase Rate 2.9 0/00
• Maternal Mortality Rate 7.3 0/0000
• Life Expectancy 73.7 Male
• 79.8 Female

Sources Ministry of
Interior,Department of Health
8
Public/Private Mix of Providers (2006)
9
Features of the Healthcare System

• Closed-staff system for hospitals
• Dominated by the private sector
• No gate-keeper system for outpatient visits
• Patients are free to choose care providers
• High service volumes in outpatient department in
  most hospitals

10
Overview of the NHI Program
11
Milestones in Social Insurance

• 1950 Labors Insurance
• 1958 Government Employees Insurance
• 1985 Farmers Insurance
• 1990 Low-income Household Insurance
• 1995 National Health Insurance
• Health insurance coverage rate before 1995 was
  59

12
Organization Chart
NHI Headquarter
Northern Region Branch
Taipei Branch
Central Region Branch
Eastern Region Branch
Southern Region Branch
Kao-Ping Branch
13
Flow of Healthcare System under the NHI
Copayment
The Insured
Providers
Medical Services
NHI Cards
Payments
Premiums
Medical Claims
BNHI
14
Characteristics of NHI (1)

• Mandatory enrollment
• Single-payer payment system
• Operated by government agency
• Payroll-related premium rate
• Contribution shared by the employer, the employee
  and the government

15
Characteristics of NHI (2)

• Comprehensive benefit package
• Fee-for-service and case payment under the global
  budget payment scheme
• Co-payment for outpatient care, inpatient care,
  and drugs

16
Enrollment Eligibility

• All Citizens
• Foreigners with resident permits
• Dependents of the aforementioned

17
Benefit Coverage

• Inpatient care
• Outpatient care
• Laboratory tests
• Prescription drugs and certain OTC drugs
• Dental services
• Traditional Chinese medicine
• Day care for the mentally ill
• Home care

18
Premium Contribution Shares (current premium
rate 4.55)
Unit
19
Calculation of Insurance Premium

• Calculation formula
• insurable income premium rate share of
  contribution (1number of dependents)
• For example Mr. Chen is a private sector
  employee with a monthly income of NT22,800 (USD
  651) and he has two dependents
• He needs to pay 22,8004.55? 30?(12)934
  (USD27) per month

(1 USD 35 NTD)
20
Copayment for Outpatient Care
UnitUSD
Copayment exemption catastrophic diseases, child
delivery, preventive health services, medical
services offered at mountain areas or offshore
islands, low-income households, veterans,
children under the age of 3
(1 USD 35 NTD)
21
Coinsurance for Inpatient Care (Acute Care)
Coinsurance ceiling US686 per stay and US1,143
cumulative for the entire calendar year (for the
same disease that causes the patient to stay no
more than 30 days in the acute ward or 180 days
in the chronic ward).
22
Exemptions of Copayment

• Catastrophic diseases
• Child delivery
• Medical services offered at the defined mountain
  areas or on offshore islands
• Low-income households
• Veterans
• Children under the age of 3

23
Relief Measures for the Disadvantaged Group

• 100 premium subsidy for low-income households
• Partial premium subsidy for the disabled, elderly
  and the jobless
• Premium Relief for the near poor payment by
  installment, donations from charity organization,
  interest-free loans

24
Development of Payment System

• 1995 - Fee for Service
• 1997 - Case Payment, currently 53 items
• 1998 - Global Budget Payment Scheme
• 2001 - Quality Based Payment Scheme
• 2004 - Resource-Based Relative Value Scale
• System (RBRVS)

25
Current Status
26
Major Achievements of NHI

• Universal coverage
• Easy access
• Affordable cost
• Fair public satisfaction
• Acceptable Quality

27
Universal Enrollment
Population Covered22 .3 million (99)

• Staying abroad
• Vagabonds are hard
• to locate

28
Easy Access

• In 2006,there were 18,289 healthcare providers
  contracted with BNHI, representing 91.45 of all
  providers
• Since1996, implemented an Integrated Delivery
  System (IDS Plan ) to improve services in remote
  mountainous areas and offshore islands.

29
Premium Revenues (Cash Basis)
Total revenues in 2006 NT367billion
(US10.5 billion)
Employer
US3.9Billion
Government
Insured
US2.6 Billion
US4.0 Billion
(1 USD 35 NTD)
30
Medical Expenditures (Cash Basis)
Total Spending in 2006 NT 423billion payment
points (US12.1 billion)
Inpatient Care
US4.2 Billion
Outpatient Care
US7.9 Billion
(1 USD 35 NTD)
31
NHI Medical Utilization
Outpatient visit per person per year
No. of hospital admission per 100 persons
32
Trend of NHI Financial Status (Accrual Basis)
Unit NTbn
33
NHI IC Card
34
Content of IC Card
NHI IC card
Explicit Data
IC Chip
Basic Data Section Healthcare Data
Section Medical Data Section Health
Administration Data Section
Name ID Number Birth date Photograph (Optional)
35
(No Transcript)
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Thank you for your kind attention!