Page 15 - 2020-2021全民健康保險年報

Balanced Finances and Sustainable Operations
Since it integrated Taiwan’s various social insurance systems in 1995, the NHI system has been operated under financial self-sufficiency, and pay-as-you-go principles. At present, the system derives its income chiefly from premiums paid by
the insured, employers, and the government, and the system also receives supplementary funds in the form of premium overdue charges, public welfare lottery earnings distributions, and tobacco health and welfare surcharges.
As Taiwan’s overall environment and demographic structure have changed, medical expenses have increased at a faster rate than premium income. Apart from acting vigorously to conserve funds and develop new sources of income, NHIA raised the premium rate in 2002 and again in 2010. Bearing in mind the insured’s ability to pay, it has also made gradual adjustments to the upper and lower limits, and intervals of the payroll bracket table used to calculate insurance premiums, and the cap on the number of dependents for whom premiums are collected. Military personnel, civil servants and teachers, whose premiums were once calculated on their base salaries, now pay premiums based on their total compensation. A supplemental premium is now collected on six types of income not previously included in premium calculations, and the lower limit of the government’s contribution is now clearly specified. All of these measures have served to stabilize NHI’s finances and maintain the NHI system’s operation and balance.
Following the implementation of the 2ndgeneration NHI in 2013, an income/expenditure linkage mechanism was established, and the
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NHI Supervisory Committee (responsible for management of income) and the NHI Medical Expenditure Negotiation Committee (responsible for negotiating expenditures) were merged as the National Health Insurance Committee. This committee, which comprises the insured, employers, medical service providers, experts and scholars, impartial public figures, and the representatives of relevant agencies, is responsible for reviewing the premium rates and the scope of insurance payments. It is also responsible for negotiating, determining, and allocating total annual medical payment expenses. It is hoped that the income expenditure linkage mechanism will ensure longterm financial stability.
The NHI system’s financial situation improved significantly following implementation of the 2nd-generation NHI, due to the collection of supplemental premiums on an expanded revenue base and the increase in the government’s overall contribution rate. The NHI’s greater sources of funding allowed collection of premiums to comply more closely with the ability to pay, and the insurance system’s financial situation improved significantly (Chart 2-1). As a consequence, inaccordance with the “NHI financial balance and revenue-expenditure linkage mechanism,” starting on January 1, 2016, the regular insurance premium rate was reduced from 4.91% to 4.69%, and the supplementary premium rate was lowered from 2% to 1.91%. In addition, in accordance with public sentiment, starting in 2016, the threshold for collecting supplementary premium for one- time professional service income, stock dividend income, interest income, and rental income payments, was adjusted upwards from NT$5,000 to NT$20,000.
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