Page 57 - TAIWAN TOBACCO CONTROL ANNUAL REPORT 2019

Second Generation Cessation Services Payment Scheme Article 14 of the WHO Framework Convention on Tobacco Control stipulated that a national smoking cessation services system should be planned and implemented. The WHO also formally passed the smoking cessation guideline in 2010, pointing out that: the national smoking cessation services program shall be based on actual evidence and provide comprehensive coverage, including: systematically identifying smokers to provide smoking cessation advice, providing a smoking cessation helpline, offering face-to-face behavior support and as-sistance by trained personnel, improving accessibility of medication that shall be provided at free or affordable prices, and systematically implementing of smoking cessation support procedures. Cessation services shall be available in various venues and service providers within and without the medical healthcare system. "Smoking" is a problem and behavior that can be eliminated, yet it still claims more than 20,000 lives a year in Taiwan, making it the most murderous challenge to national health. Taiwan has been providing smoking cessation therapy paid by health and welfare surcharges since 2002. Nicotine addicts above 18 years of age (those scoring at least 4 points on the new Fagerström test or smokes 10 or more cigarettes a day) were provided with 2 treatment sessions every year, with each treatment providing up to 8 weeks of medication, and short-term counselling services. Smokers also enjoyed subsidies for smoking cessation medication and doctor's services. If fixed cost were provided with NT$250 per week for smoking cessation medication, smokers may still have to pay NT$550-1,250 of expenses which may be too high for those with lower income. Hence, a key topic for eradicating health inequality would be identifying measures that reduce economic barriers preventing people from accessing smoking cessation treatments. To help more smokers quit smoking, the second generation cessation services payment scheme was launched on 1st March, 2012. Payment subsidies derived from the health and welfare surcharge include smoking cessation treatment fees, case tracking fees, health education, and case management fees. Medication fees would be copaid 20% in accordance with official announcements on general medication for the National Health Insurance program, where a maximum copayment of NT$200 would be required. The HPA further announced that 20% subsidy provided for copayment in medical disadventaged areas, in terms of free medication for low-income households, indigenous people, and those living in mountainous areas and offshore islands. Cessation treatments were also expanded from outpatients to inpatients, emergency room patients. In September 2012, community pharmacies began to offer medication provision as well as smoking cessation education and case management. In addition to providing accessible, professional services by the pharmacists, and flexibility of service time, smokers were also given personalized counselling and support. Such measures were designed to improve smoking cessation for community residents. One-on-one as well as face-to-face services were carried out by smoking cessation instructors during quit courses and case management. Resources within the resources were also integrated, allowing the HPA to actively promote smoking cessation within workplaces, school campuses, and other institutions to provide smoking cessation healthcare education, counselling, and training. Once more smokers take the initiative to utilize smoking cessation therapy, the total number of successfully quit smoking cases would increase as well, giving positive contributions to the reduction of smoking population. Upon assessment of a significant increase in case numbers and success rates of the pilot program, services are now provided on a permanent basis. In 1st May, 2014, the HPA successfully added dentists and assistant pharmacists as part of the smoking cessation service team. Dentists are often able to detect oral symptoms resulting from tobacco use, and therefore have the privilege 55 Reducing the Demand for Tobacco