Page 35 - 2018-19全民健康保險年報

給付完整 就醫便利
Comprehensive Benefits and Convenient Access
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表3-3 Table 3-3
病房別
Ward
急性病房
Acute
全民健保住院部分負擔
Coinsurance Rates for Inpatient Care
5%
部分負擔比率
Copayment Rates
10% 20%
30% 61日以上
61 days or more
-
30日內
30 days or less
31∼60日 31-60 days
181日以上 181 days or more
慢性病房
Chronic
30日內
30 days or less
31∼90日 31-90 days
91∼180日 91-180 days
註: 依衛生福利部公告，2018年以同一疾病每次住院上限為38,000元、全年累計住院上限為64,000元。
Note: The Ministry of Health and Welfare has announced that the upper limit of inpatient copayments for the same disease is
NT$38,000 in 2018, and the upper limit of cumulative inpatient copayments is NT$64,000.
the basic copayment for attending a Western medicine outpatient clinic at a hospital depends on whether or not an individual has a referral. If people seek care directly at a medical center, regional hospital, or local hospital without a referral, they will be subject to relatively high copayments. The copayment for dental and Chinese medicine care is uniformly NT$50 without regard to level of care. In addition, if a prescription costs more than a certain amount, a copayment for the medication is also charged(up to NT$200). Patients receiving follow-up rehabilitation physical therapy(apart from moderate-complex, complex items)or Chinese medicine trauma treatment for the same course of treatment must pay copayments of NT$50 each time, but such copayments are waived in cases of major illness and injury, child delivery, those who seek care in mountain and offshore island areas, and other cases complying with NHIA regulations.
Starting in June 2016, the NHIA has stepped up the planning and implementation of hierarchically integrated healthcare system in an effort to encourage the public to first seek care at primary care level hospitals and clinics, and if needed they would be referred to an appropriate specialist
hospital department or clinic for further care. This approach will enable large hospitals to devote their full attention to treatment of serious illnesses and medical research, while making primary-level hospitals and clinics the frontline of primary care. The revised basic copayment schedule for Western medicine outpatient care announced by the NHIA on April 15, 2017 reduced copayments for referrals to medical centers and regional hospitals by NT$40, and increased copayments for medical care at a medical center without a referral by NT$60. Furthermore, copayments for emergency care are now charged depending on triage grade. These measures ensure the realization of two-way referrals. Outpatient and inpatient copayments are shown in tables 3-2 and 3-3.
Following the implementation of the 2nd Generation NHI, in order to benefit areas with limited medical resources, where it may be difficult to seek care outside, people living in such areas enjoy a uniform 20% reduction in copayments, and the copayment rate for home health care has been reduced to 5% from the original 10%.
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Chapter