Page 37 - 2018-19全民健康保險年報

Family Doctors and Community Pharmacies
To ensure that the public can obtain comprehensive and continuing medical care near their homes, the NHIA introduced the “NHI Family Doctor Plan” in March 2003. Under this plan, five or more NHI-contracted western medicine clinics in the same area can join with a community hospital to form a community health care group. As long as they take a doctor at a primary-level clinic near their home as their family doctor, people can obtain front- line healthcare. Family doctors should ordinarily serve as preventive healthcare consultants, and should bear responsibility for gathering medical data and providing 24-hour health consulting service hotlines. If patients’ conditions warrant surgery, further examination, or hospitalization, their family doctors can provide referrals. The family doctor system is intended to reduce wasted time and money when people must find a doctor.
As of the end of June 2018, 567 community healthcare groups were operating, 4,558 primary- level clinics were participating, which represented a participation rate of 43.6%, 5,924 doctors were participating, for a participation rate of 37.8%, and more than 4.73 million persons benefited from community healthcare groups.
With regard to pharmacy services, individuals can obtain medication from a contracted pharmacy upon presentation of a prescription from a contracted hospital or clinic. If patients have any questions about their prescription, they can ask their pharmacist or assistant pharmacist at a pharmacy to provide usage and health consulting services. Pharmacies not only keep tabs on the public’s medication safety, but also provide the public with correct medication usage knowledge.
給付完整 就醫便利
Comprehensive Benefits and Convenient Access
Diversified Payment Systems
The NHI’s payment system relies on a third- party payment mechanism, and the NHIA pays the medical expenses of persons seeking care to hospitals and clinics on the basis of the NHI fee schedule. The design of the medical expense payment system plays an important role in achieving a reasonable, fair, and effective NHI system.
When the NHI system was initiated, it sought to quickly integrate the existing civil service, labor, and farmers’ insurance systems, and encourage hospitals and clinics to apply to become contracted health insurance organizations. The fee-for-service approach was adopted as the primary payment system, and taking the government and labor insurance payment standards as a basis, the NHI’s payment standards were revised in conjunction with adjustment of the scope of reimbursements and the recommendations of medical groups. However, this system resulted in an uncontrolled increase in medical expenses, and has affected the quality of care.
Accordingly, the NHIA has followed the example of other leading countries by designing different payment methods based on the characteristics of different types of medical care. For instance, the NHIA implemented global budget payment system in a full scale since July 2002, and simultaneously employed different revised payment strategies, such as case payment and pay-for- performance(P4P)to change treatment behavior. In addition, the Integrated Delivery System(IDS) implemented by the NHIA in mountain areas and on offshore islands has enhanced integration of the medical service system, and the NHIA also provides payments on the basis of quality and outcomes through pay-for-performance plans. Furthermore, to enhance patient health and medical efficiency,
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