National Health Insurance Administration Ministry of Health and Welfare

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NHI Medical Treatment Revision in Preparation

    Since the comprehensive implementation of the NHI IC card in 2004 the public" + String.fromCharCode(39) + "s treatment verification document has gone from paper to an IC card and there have been adjustments made in the procedure for doctor" + String.fromCharCode(39) + "s visits and medical care services of medical institutions. To conform to the authorization goal of the NHI Act and current needs, the DOH announced on August 2 that treatment under the NHI system had been revised to make treatment visit procedures and diagnostic and treatment services of medical institutions clearer and more transparent and clarify rights and responsibilities.

    Following the procedural revision it has been determined that each time a medical institution offers medical services, both clinic and hospital, in addition to making a record on the IC card, data on the visit shall be forwarded to higher authorities within 24 hours. Aside from providing an understanding of medical care utilization, this can also provide timely information to the DOH for epidemic prevention policy. Further, considering chronic diseases of sailors on deep sea fishing boat voyages and of bed-ridden or semi-ambulatory patients, this revision relaxed the provisions regarding third persons being authorized to relay information about an illnesses to physicians and acting as agents to receive medications. In addition, focusing on people who inappropriately utilize NHI resources and duplicate treatment visits, and based on the principle of holding down resource waste, this revision also determined that the BNHI can give appropriate guidance on treatment visits and establish limits on coverage with regard to medical care utilization. With regard to discussions by all segments of society on whether the period of validity of the Chronic Illness Prescription Refill Card should be extended to six months, following the DOH consideration of the opinions of clinical specialists and conclusions from discussion meetings, and based on the professional considerations of disease diagnosis and treatment, disease follow-up and medication safety, the current three-month period of validity will be temporarily maintained. The DOH will continue to study and discuss the feasibility of this extension in line with clinical needs.

    In addition to the primary revisions mentioned above, professional medical opinions have been consulted and "chronic urticaria" has been listed as a chronic disease. Doctors may, as the conditions require, provide a 30-day supply of medication or provide medication using the Chronic Illness Prescription Refill Card. This can reduce the number of treatment visits a patient will make. Also, this revision has added sailors on deep sea fishing boats who have a Chronic Illness Prescription Refill Card. They may, before putting out to sea, just like anyone else, follow the approach for being out of the country for more than one month. With a "Port Clearance Certificate" they can follow the regulations permitting them to obtain the following month" + String.fromCharCode(39) + "s supply of medication. In addition, to guarantee the public" + String.fromCharCode(39) + "s rights and interests, in addition to the stipulation of the original procedures where medical institutions were obligated to inform people in advance of categories and situations for which there would be no reimbursement, this revision has the added stipulation that hospitals shall inform people in advance of cost categories they will be responsible for covering themselves during a hospital stay thus further reducing the number of disputes between hospital and patient.

    To carry out the laws and regulations and provide guidelines to follow for doctor visits and medical institution operations in coordination with the current procedural revision, the BNHI has recently studied and discussed the implementation principles relating to third parties obtaining medication on behalf of chronically ill patients who are bed-ridden or semi-ambulatory and those relating to sailors on deep sea ships with port clearance certificates. Also, with regard to guidance and reimbursement limits relating to the inappropriate use of NHI resources and duplicate doctor visits, aside from a primary emphasis on a continued guarantee of meeting treatment needs and guidance for the critically and seriously ill, clear operating principles have been set up for delineating "duplicate doctor visits" and "waste of medical resources," for limiting the number of doctor visits and for non-reimbursable items. This has been done to achieve the goal of a delegation of authority that is comprehensive and conforms to the NHI Act.

  • Date:2006-08-22