Hongjen Chang, MD, MPH, MS

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Where are we in IT Taiwan's National Health
Insurance

• Hong-jen Chang, MD, MPH, MS
• CEO and President
• Bureau of National Health Insurance
• Taiwan, June 7, 2004

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Contents

• A brief introduction to Taiwans National Health
  Insurance
• Information Technology in NHI
• Key features for Taiwans e-health
• Conclusion

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Japan
China
USA
Profile of Taiwan(2002) Population 22.52 million
Land area 36,188 km2 (14,000 mile²) Population
density 622 per km2 Population aged over 65
9.02 GNP per capita US 12,900 NHE as of
GDP 5.99
Map of Taiwan, ROC
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Health Indices (2002)

• Crude Birth Rate 11.02 0/00
• Crude Death Rate 5.73 0/00
• Natural Increase Rate 5.29 0/00
• Infant Mortality Rate 5.35 0/00
• Maternal Mortality Rate 7.68 0/0000
• Life Expectancy 73.03 Male
• 78.82 Female

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Milestones in Social Insurance

• 1950 Labor Insurance (40.12)
• 1958 Government Employee Insurance (8.06)
• 1985 Farmer Insurance (8.21)
• 1990 Low-income Household Insurance (0.55)
• 1995 National Health Insurance (99)
• ( ) indicates of covered population

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Characteristics of the Healthcare System

• Dominated by the private sector
• Closed-staff system for hospitals
• Patients are able to choose care providers freely
• No gate-keeper system
• Hospitals accredited by DOH every 3 years
• High service volumes in outpatient department in
  most hospitals

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Characteristics of NHI (1)

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

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Characteristics of NHI (2)

• Cost sharing for ambulatory care, inpatient care,
  and drugs
• Comprehensive benefit package
• Fee-for-services under the Global budget

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US Dollars
Information resource 1. OECD Health
Data,20002002 2. International Health
Policy?Chart VIII-1 from Multinational
Comparisons of Health System Data,2000
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National Health Expenditures as in GDP1983-2002
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High Public Satisfaction
(19952004)
Satisfied (DOH) Satisfied (BNHI)
Dissatisfied (DOH) Dissatisfied (BNHI)
1995/5 1995/9 1996/6 1998/1
1998/4 1998/11 1999/5 2000/3
2000/10 2001/6 2001/12 2002/5 2002/8
2002/11 2003/7 2004/4
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• Information Technology in NHI

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Electronic Medical Claims
The Rate of Claims through Electronic Media
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IT/Information Management for Efficiency

• Electronic claim processing system
• Uniform reporting procedure and format
• Standardize coding system
• Comprehensive databank
• Data Warehouse for Decision support
• Profile analysis system for utilization review
  and management
• Web site provide information sharing with
  providers

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NHI Smart Card

• A new milestone for NHI
• Pilot on Pescadores in May 1995.
• Formally implemented in January 2004
• Provide timely information on where and when
  patient received healthcare services

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Content of Smart Card
NHI smart card
Explicit Data
IC Chip
Basic Data Section Healthcare Data
Section Medical Data Section Health
Administration Data Sec.
Name ID Number Birth date Photograph (Optional)
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Change of Management

• Monthly monitor of medical expenditure
• Eligibility checkup while renew paper card
• Periodically data exchange with CDC

• Daily monitor of utilization
• Instant checkup of patients eligibility
• Daily monitor of communicable disease
• SARS
• Inbound traveler or immigrant

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Future Phase-In Plans

• Organ donation
• Weekly monitor of hospital expenditure

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• Key Features for Taiwans e-Health

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Taiwans e-Health (1)

• People enjoy information technology
• Mobile phone subscribing rate 106.5 (ITU 2003)
• Internet subscribing rate 38
• Digital Access Index No.9 in the world
• System is designed to maximize benefit from IT
• Unique identity card for every resident in Taiwan
• BNHI set up various common standards for IT
  implementation
• NHI smart card project provide network linkage
  environment

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Taiwans e-Health (2)

• Integrated databank
• Medical claims integrate with other data base to
  provide population-based information
• Valuable databank for researchers, healthcare
  providers and policy-makers
• Privacy protection and security challenges
• Patient groups AIDS
• Human right groups

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Planning of NHII Project

• Initiating national health information strategic
  plan to establish national health information
  infrastructure (NHII).
• Invest from public sectors USD 670 million in the
  next 5 years.
• Joint venture of public, private sectors,
  academics and industries.

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Objectives of NHII Project

• Establish an interoperable integrated health
  information platform.
• Set up an information framework to support
  continuous healthcare services.
• Acute care
• Chronic care
• Health promotion
• Comprehensive national healthcare databanks to
  support RD

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Proposed Strategic Areas of NHII

• Healthcare Information Technology
• NHI Smart card
• Personal Health informatics
• Electronic Health Record(EHR)
• Public Health and Medical informatics
• Clinical decision support and patient safety
  system
• Disease Surveillance
• Ethical, Legal and Social Implications

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• Conclusions

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Taiwans NHI system

• Affordable
• Accessible to all
• High public satisfaction
• Quality of care Acceptable

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Possible factors contributing tothe success of
Taiwans NHI

• Single-payer system
• Free market on delivery side
• IT intensive operating system
• Strong generic pharmaceutical industry
• Physicians willing to work very hard at
  relatively low physician fee
• Tradition of family support
• Good doctor-patient relationship

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Thank you !