Page 17 - 2018-19全民健康保險年報

Health Care for All with Equal Right to Healthcare
The government’s original intention in providing the National Health Insurance program was to provide health security to all citizens via a mutually assisted system. The system was designed to ensure that everyone enjoyed equal rights to healthcare, including groups outside the working population prior to the system’s inception, such as dependents, veterans, and the unemployed, including women, students, children, and the elderly. The inclusion of these groups in the program meant that all citizens have equal rights to access medical services when they get sick, are injured, or give birth. Based on this framework, all persons who are citizens of the Republic of China (Taiwan) and have had a registered domicile in the Taiwan area for six months or more, and all infants born in the Taiwan area, must participate in the NHI program. There are six categories of insureds (Table 2-1), which provide the basis for the calculation of insurance premiums.
In line with recent societal changes and in consideration of human rights and the principle of fairness, the NHI system has been revised several times over the years. Coverage has gradually expanded to include new immigrant residents, foreign white collar workers stationed in Taiwan long-term, overseas Chinese and foreign students, and military personnel within Taiwan’s NHI system.
To further achieve the vision of equal access to treatment and right to medical care, following the implementation of second-generation health insurance, inmates at correctional facilities have also been included in the system. ROC nationals who have lived abroad for an extended period of time and wish to re-enroll in the program must now
全民有保 財務永續
Universal Coverage and Financial Sustainability
have either participated in the system at some point during the previous two years or have established residency in Taiwan for at least six months in a row to be eligible. Foreigners must also have resided in Taiwan for at least six months before they can participate in the system. These changes reflect society’s expectation of fairness and justice.
As of the end of June 2018, a total of 23,848,272 people were participating in NHI (Table 2-2), and there were 893,289 insured units.
Balanced Finances and Sustainable Operations
Since it integrated Taiwan’s various social insurance systems in 1995, the NHI system has been operated under financial self-sufficiency, and pay-as-you-go principles. At present, the system derives its income chiefly from premiums paid by the insured, employers, and the government, and the system also receives supplementary funds in the form of premium overdue charges, public welfare lottery earnings distributions, and tobacco health and welfare surcharges.
As Taiwan’s overall environment and demographic structure have changed, medical expenses have increased at a faster rate than premium income. Apart from acting vigorously to conserve funds and develop new sources of income, NHIA raised the premium rate in 2002 and again in 2010. Bearing in mind the insured’s ability to pay, it has also made gradual adjustments to the upper and lower limits, and intervals of the payroll bracket table used to calculate insurance premiums, and the cap on the number of dependents for whom premiums are collected. Military personnel, civil servants and teachers, whose premiums were once calculated on their base salaries, now pay premiums based on their total compensation. A
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