National Health Insurance in Taiwan

1
National Health Insurancein Taiwan

• Bureau of National Health Insurance
• 2008

2
Overview of the NHI Program
3
Milestones in Social Insurance

• 1950 Labor 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

4
Organization Chart
NHI Headquarter
Northern Region Branch
Taipei Branch
Central Region Branch
Eastern Region Branch
Southern Region Branch
Kao-Ping Branch
5
Flow of Healthcare System under the NHI
Copayment
The Insured
Providers
Medical Services
NHI Cards
Payments
Premiums
Medical Claims
BNHI
6
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

7
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

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Enrollment Eligibility

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

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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

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Premium Contribution Shares (current premium
rate 4.55)
Unit
11
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 NT30,300 (USD
  918) and he has two dependents
• He needs to pay 30,3004.5530(12)1,241
  (USD38) per month

(1 USD 33 NTD)
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Copayment for Outpatient Care
UnitUSD
Copayment exemption 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)
13
Coinsurance for Inpatient Care (Acute Care)
Coinsurance ceiling US788 per stay and US1,333
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)
14
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

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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

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Provider Payment

• 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)

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Current Status
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Major Achievements of NHI

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

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Universal Enrollment
Population Covered22 .3 million (99)

• Staying abroad

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Easy Access

• In 2007,there were 18,540 healthcare providers
  contracted with BNHI, representing 91.75 of all
  providers
• Since1996, implemented an integrated delivery
  system (IDS Plan ) to improve services in remote
  mountainous areas and offshore islands.

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Premium Revenues
Total premium revenues in 2007 NT370billion
(US11.2 billion)
Employer
US4.0Billion
Government
Insured
US2.8 Billion
US4.4 Billion
(1 USD 33 NTD)
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Medical Expenditures
Total medical claims in 2007 NT 440billion
payment points
(US13.3 billion)
Inpatient Care
US4.5 Billion
Outpatient Care
US8.8 Billion
(1 USD 33 NTD)
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NHI Medical Utilization
Outpatient visit per person per year
No. of hospital admission per 100 persons
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Trend of NHI Financial Status
Unit NTbn
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NHI IC Card
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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)
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High Satisfaction
(19952007/12)
Satisfied (DOH) Satisfied (BNHI)
Dissatisfied (DOH) Dissatisfied (BNHI)
Premium Copayment Adjusted
05/95 09/95 06/96 01/98 04/98
11/98 05/99 03/00 10/00 06/01 12/01 05/02
11/02 07/03 12/03 04/04 09/04 12/04 06/05
12/05 06/06 12/06 06/07 12/07
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Thank you for your kind attention!