National Health Insurance in Taiwan

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National Health Insurancein Taiwan
Bureau of National Health Insurance
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Taiwan 2007
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Social Insurance in Taiwan

• 1950 Labor Insurance (40.1)
• 1958 Government Employees Insurance (8.5)
• 1985 Farmers Insurance (8.2)
• 1990 Low-income Household Insurance (0.6)
• 1995 National Health Insurance (99)

( ) indicates of total population.
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Characteristics of NHI
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Financing
Other revenues

• Lottery revenues
• Tobacco excise tax

Payments
Premiums
Copayment
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Contribution Shares
Premium rate 4.55
Unit
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Copayment for Outpatient Care
UnitUS
Copayment is partially waived for visits
referred by primary physicians.

• Exemptions
• Catastrophic diseases, child delivery
• Medical services offered at mountain areas or
  offshore islands
• Low-income households, veterans, children under
  the age of 3

(1 USD 33 NTD)
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Coinsurance for Inpatient Care (Acute Care)
Coinsurance ceiling US900 per stay and US1,500
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).
(1 USD 33 NTD)
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Benefit Package

• Inpatient care
• Outpatient care
• Laboratory tests
• Prescription drugs and certain OTC drugs
• Dental services (orthodontics, prothodontics
  excluded)
• Traditional Chinese medicine
• Day care for the mentally ill
• Home nursing care

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Reimbursement Schemes
1995
19982002
2004
2010
4 sectoral budgets 1998 Dental care 2000
Traditional Chinese Medicine 2001 Clinics 2002
Hospitals
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Access to Medical Care

• Patients are free to choose from 18,829 providers
  for medical services.
• No waiting list as defined in western countries.
• Integrated delivery system (IDS) was implemented
  to improve services in remote mountainous areas
  and offshore islands.

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The NHI Alleviates Financial Burdens of
Disadvantaged Groups

• Patients with catastrophic diseases represent
  3.1 of population, who used 27.1 of NHI medical
  expenditures.
• The elderly people represent 10 of population,
  who used 32.7 NHI medical expenditures.

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Assistances for the Disadvantaged
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Two New Measures for Disadvantaged Groups

• Raising the tobacco tax to help the near poor to
  pay the National Health Insurance premiums
• National lottery funds to reduce copayment for
  the indigent and repay their accumulated premiums
  bills

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NHI Financial Status
Unit NTbn
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NHI Medical Utilization
Outpatient visit per person per year
No. of hospital admission per 100 persons
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Functions of NHI IC Card

• Utilization Monitoring
• Managing high-utilization case through profile
  analysis
• Anti-fraud
• Detecting aberrant medical claims
• Surveillance of Public Hazards
• Tracking down suspects of communicable diseases
  e.g. SARS

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Assured Quality of Care

• Life Expectancy 75.1 Male 81.9 Female
• Post-NHI Increase rates in LE twice that of
  Pre-NHI
• Health Disparities narrowed
• Infant Mortality Rate 5.0 0/00
• Crude Death Rate 6.1 0/00
• Maternal Mortality Rate 7.3 0/0000

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Up-to-standard Quality
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Major Achievements of NHI

• Universal coverage
• Easy access
• Affordable cost
• High public satisfaction
• Up-to-standard quality

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Public Satisfaction
(20012008)
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Future Plan

• Broad-based premium and multiple-source revenue
  for financial sustainability
• Quality Enhancement

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Thank you for your kind attention!