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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Organization Chart
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Operational Status of BNHI

• No. of employees 2,592 persons
• Business volume
• Premium revenues US11.6 billion/year
• Medical Expenses US12 billion/year
• Customers
• Insured 22,891,972 persons
• Group insurance unit 674,589 units
• Contract providers 18,640 institutions
• Coverage rate 99
• Administrative cost as a of medical
  expenditures 1.48
• Public satisfaction rate 79.3

US1NT33
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Financing
Other revenues

• Lottery revenues
• Tobacco excise tax

Payments
Premiums
Copayment
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Contribution Shares
Unit
Premium rate 4.55
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Co-payment for Outpatient Care
UnitUSD
Co-payment discounts are available for visits
referred by primary physicians.

• Exceptions
• Catastrophic illness, 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 US848 per stay and US1,424
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 care

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Provider Payment
1995
19982002
2004
2008
4 sectoral budgets 1998 Dental care 2000
Traditional Chinese Med. 2001 Clinics 2002
Hospitals
(Developed but not yet implemented.)
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Access to Medical Care

• Patients are free to choose among 18,640
  providers (91.75 nationwide) for medical
  services.
• No waiting lines as defined in western countries.
  
• Integrated delivery system (IDS) was implemented
  to improve services in remote mountainous areas
  and offshore islands.
• Telemedicine helicopter service in every islet.

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Assistances for the Disadvantaged
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Functions of NHI IC Card

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

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NHI Financial Status
Unit NTbn
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Sources of Premium Revenues
Total premium revenues in 2007 NT370billion
(US11.2 billion)
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NHI Medical Spending
Total medical claims in 2007 NT440billion
(US13.3 billions)
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NHI Medical Utilization
Outpatient visit per person per year
No. of hospital admission per 100 persons
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The NHI Alleviates Financial Burdens of
Disadvantaged Groups

• Major illness patients represents 3.1
  population, who used 27.1 of NHI medical
  expenditures.
• The elderly people represents 10 population, who
  used 32.7 NHI medical expenditures.

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Average Annual Growth Rate of NHE(1997-2006)
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Public Satisfaction
(20012008)
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Major Achievements of NHI

• Universal coverage
• Easy access
• Affordable cost
• High public satisfaction
• Acceptable quality

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Future Plan

• Amending NHI Laws
• To redefine premium calculation base from
  payroll to income based calculation.
• Allow more public participation in the health
  insurance policy making process.

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Thank you for your kind attention!