Page 33 - 2018-19全民健康保險年報

Scope of Medical Coverage
When insureds, who have paid their NHI premiums and have received their health insurance cards, get sick, injured in an accident, or give birth, they can receive medical services at medical service organizations such as hospitals, clinics, pharmacies, and medical examination organizations upon presentation of their health insurance card.
The medical services currently provided by the NHI include outpatient care, inpatient care, traditional Chinese medicine(TCM), dentistal care, child delivery, physiotherapy and rehabilitation, home health care, chronic mental illness rehabilitation, and etc. The scope of medical payments includes diagnosis, examination, lab tests, consultation, surgery, anesthesia, medication, materials, treatment, nursing, and insurance hospital rooms; essentially all necessary health care services are covered by the system.
Convenient Access to Healthcare
Under the NHI system, the public can freely choose to receive medical care services at any NHI contracted hospital, clinic, pharmacy, or medical laboratory. Even when overseas, the insured can immediately obtain medical care at a local medical service organization if they have an unforeseen illness or injury, or have an emergency delivery. Upon return to Taiwan, such individuals may apply for reimbursement of medical expenses paid overseas within six months after receiving emergency treatment, outpatient treatment, or their hospital discharge. The reimbursement will be based on the average payment for domestic hospitals and clinics.
As of the end of June 2018, NHI contracted hospitals and clinics totaled 21,163, and accounted
給付完整 就醫便利
Comprehensive Benefits and Convenient Access
for 92.86% of all hospitals and clinics in Taiwan (Table 3-1). There were also 6,272 contracted pharmacies, 613 home nursing care institutions, 210 psychiatric community rehabilitation centers, 17 midwife clinics, 211 medical examination institutions, 22 physical therapy clinics, 7 medical radiation institutions, 3 occupational therapy clinics, and 1 respiratory care clinic. Insureds may freely choose at which hospital or clinic they will receive medical services.
In 2017, the average per capita outpatient visit reached an average of 15.1 times (including Western medicine, Chinese medicine, and outpatient dental care); the average hospital admission rate was 14 times per hundred persons; and the average length of hospital stay per person was 1.4 days.
Adjusting Copayments and Realizing Two-way Referrals
The NHI copayment system was designed to avoid waste, without affecting access to medical care for those truly in need. Since the NHI’s inception, the copayments for outpatient and emergency care have been adjusted multiple times. The NHIA has used copayments as a means to guide medical resource utilization to ensure that hospitals and clinics at different levels focus on their respective duties.
To encourage persons with minor illnesses to seek care at local clinics, and obtain referral to regional hospitals, medical centers, and other larger hospitals only when further examination or more advanced treatment is needed. On July 15, 2005, the NHIA modified the copayment and referral system whereby basic outpatient copayments were revised and copayments will not increased if patients conform with referrals. Under these measures,
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