Page 7 - 2018-19全民健康保險年報

As the Director General of National Health Insurance Administration, it is always our priority to improve Taiwan’s National Health Insurance (NHI) and taking it to the next level. At the end of 2018, the public satisfaction with the National Health Insurance (NHI) reached a record high of 86.5%. However, in order to achieve sustainable development, all system must go through the process of implementation, review, and improvement. Provided there is no obstacles over medical treatment people can receive, improving medical environment would be our main focus in the future.
Nowadays, the Ministry of Health and Welfare and the National Health Insurance Administration are actively promoting a tiered healthcare system, hoping to guide the people to change their medical care seeking behavior, promote the division of labor in medical institutions, and prevent major hospitals from being filled with mild disease patients, which keep ER and critically ill patients from receiving appropriate treatment.
Therefore, since July 2018, the NHI has implemented the policy of “reducing the number of outpatient clinic cases by 2% for hospitals above the regional level” and related referral incentive measures in order to encourage major hospitals to refer their stable chronic patients or patients in need of simple surgical procedures to community hospitals and clinics, allowing medical staff of major hospitals to concentrate on the medical treatment of acute and severe diseases, so as to balance medical resource allocation.
In addition, the NHIA has actively strengthened the “NHI MediCloud System” features. In 2018, the CT, MRI, ultrasound, microscopic exams, X-ray, and other medical imaging features were added to enable physicians
to view examination images and reports from major hospitals, which shall serve as a reference for diagnosing patients’ conditions. Through cloud data sharing, repeated medical care can be prevented, thereby aiding in implementing a sound healthcare system.
From the NHI big data, it is shown that NHI medical expenditures grow at a rate of about 5% annually. Among them, expenditures on patients’ examinations and checkups significantly exceeds those of physicians’ diagnosis and treatment fees and other services, let alone short-term repeated examinations and excessive medication claims due to repeated medical attention, leading to medical waste. In the future, the NHIA will adopt big data to perform accurate reviews, so as to reinforce auditing on illegal reporting, false reporting, and over-reporting of NHI medical claims. The NHIA and the medical community shall jointly manage unnecessary medical activities in order to reinvest resources in new drugs, new technologies, and the improvement of medical environment.
It is never too late to carry out NHI reform. We must get started to make the change. We hope that our people will support NHI reform, reduce unnecessary medical waste in concerted efforts, and properly reinvest medical resources to improve the medical environment, which will bring benefits to all.
Po-Chang Lee
Director General National Health Insurance Administration Ministry of Health and Welfare
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