Page 51 - 2018-19全民健康保險年報

physicians. For the “named review part”, depending on the willingness of reviewing physicians, it is divided into two types: “individual reviewer named deduction cases” and “reviewer groups named”. For the former, seven departments, namely, pediatrics, obstetrics and gynecology, otolaryngology, ophthalmology, neurology, psychiatry, and urology, have carried out the pilot plan in some areas; for the latter, names are announced through the NHI information network service system. As of the end of 2017, the consent rate reached 51%. After the pilot plan was carried out, medical expenditure deduction dispute cases decreased from 104 thousand cases in 2015 to 55 thousand cases in 2017, thus achieving the purpose of “reducing disparity in individuals’ professional opinions and enhancing medical expenditure deduction reasonability”.
Transparent Medical Quality Information
In 2005, the NHIA launched a platform to provide transparent information on healthcare quality in an effort to encourage the medical community to improve care quality. The platform was also designed to enhance public understanding of medical quality and medical utilization under NHI, and provide guidance to patients making decisions about their healthcare choices. This platform includes professional healthcare service quality reports, medical quality indicators of contracted hospitals and clinics, customer service indicators, and indicators concerning specific diseases, and can help the public gain an understanding of the quality of care in Taiwan.
Furthermore, basic information concerning contracted medical organizations, including service items, examination and treatment departments, scheduled visiting hours, insurance bed ratios,
專業審查 提升品質
Professional Review and Quality Improvement
information on medical organizations violating NHI rules, and registration fee queries are made public online.
Reasonable Drug Price Adjustments
Under the current system for reimbursing medication expenses, medical organizations file drug expense claims with the NHIA based on NHI Drug List, and the NHIA will gather actual transaction prices through regular drug price market surveys to adjust drug prices periodically.
Since 1999, drug prices have been reduced based on these market surveys by a cumulative total of more than NT$60 billion. These periodic adjustments in drug prices have not only helped shrinking the gap between actual market prices and NHI reimbursement prices, but also slowed the growth of the system’s medication expenditures. The funds saved are being used to accelerate the inclusion of new drugs, widening the scope of drug payments, adjusting the payment standards for items with relatively low prices, the NHIA is ensuring that patient access to drugs is on a par with the world’s leading countries while improving the quality of healthcare in Taiwan. This is one way the NHIA used to safeguard people’s health.
To further control health insurance medication costs as a whole, it has been 5 years since the NHIA announced trial implementation of the four- year “NHI Drug Expenditure Allocation Ratio Target System” from January 1, 2013. This system sets yearly targets for NHI drug expenditures, which are linked with actual drug expenditures. If actual expenditures exceed targets, a process to lower drug prices is automatically initiated once each year, keeping the NHI system’s overall spending on drugs stable and within a reasonable scope.
49
4
Chapter