Page 43 - 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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註:高血壓方案自2006年起於西醫基層開始試辦，2007年則擴大至醫院，其照護率因涵蓋基層診所及醫院，呈現照護率下降情形，又 因病患常合併多重疾病，例如糖尿病、慢性腎臟病等，故未再以疾病別單獨另列計畫追蹤，自2013年起停止試辦。早期療育門診 醫療給付改善方案自2015年10月實施、慢性阻塞性肺病自2017年4月實施。
Note: The hypertension plan was first implemented on a trial basis at Western medicine clinics starting in 2006, and was expanded to hospitals in 2007. Because the care rate for this plan encompasses both primary-level clinics and hospitals, the care rate for this plan decreases. Furthermore, because hypertension patients commonly also have such comorbidities as diabetes and chronic kidney disease, these conditions were no longer tracked under other independent plans, and trial implementation of the plan was ended in 2013.
An early intervention outpatient medicine pay-for-performance plan was implemented in October 2015, and a chronic congestive lung disease plan was introduced in April 2017.
the service capacity of basic western medical clinics and extend the service scope, the Western medicine primary care global budget department has allocated a budget of NT$250 million. Beginning on May 1, 2017, “influenza A virus antigen” and others totaling 25 service items are available at primary care medical institutions.
Pay-for-Performance Plans
The NHIA’s pay-for-performance plans are intended to adjust medical expense reimbursements to hospitals and clinics while providing appropriate incentives to induce medical service providers to develop and provide holistic healthcare. As a consequence, medical quality and effectiveness are taken as a basis for the reimbursement of expenses. The NHIA phased in this pay-for- performance system starting in October 2001 to cover payments for the treatment of cervical cancer, breast cancer, tuberculosis, diabetes, and asthma based on well-defined clinical criteria.
The management of the cervical cancer program was transferred to the Health Promotion Administration in early 2006, but that same year, and a pay-for-performance plan for hypertension treated at Western medicine clinics was added. In 2007, hospitals became eligible to treat hypertension under the plan, and in 2008, pay-for- performance for the treatment of tuberculosis was included in the NHI fee schedule. Two additional
pay-for-performance plans were added in January 2010: for schizophrenia and for hepatitis B carriers and hepatitis C patients, and another plan was introduced in January 2011 for early chronic kidney disease. Pay-for-performance plan for chronic kidney disease was included in the NHI fee schedule in April 2016.
In 2015, the NHIA took back management of the pay-for-performance program covering full- course maternity care for pregnant women, which had previously been managed by the Ministry of Health and Welfare’s Medical Development Fund. A pay-for-performance plan for early intervention outpatient therapy was added in October of the same year, and a pay-for-performance plan for chronic congestive lung disease was added in 2017.
Thanks to the positive impact of the diabetes pay-for-performance plan, it was adopted in the fee schedule for all diabetes cases in October 2012. Furthermore, since the patients under the hypertension plan commonly also had such comorbidities as diabetes and chronic kidney disease, etc., to promote holistic care methods, these conditions were no longer listed as independent items starting in 2013, and were included in other pay-for-performance plans. The recent care rates of each plan are shown in Table 3-5.
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