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The NHI payment system relies on a third-party payment mechanism, and the NHIA pays the medical expenses of persons seeking care to hospitals and clinics on the basis of the NHI fee schedule. The design of the medical expense payment system plays an important role in achieving a reasonable, fair, and effective NHI system.
     Accordingly, the NHIA has followed the example of other leading countries by designing different payment methods based on the characteristics of different types of medical care. For instance, the NHIA implemented the global budget payment system in a full scale since July 2002, and simultaneously employed different revised payment strategies, such as case payment and pay-for-performance (P4P) to change treatment behavior. In addition, the Integrated Delivery System (IDS) implemented by the NHIA in mountain areas and on offshore islands has enhanced integration of the medical service system, and the NHIA also provides payments on the basis of quality and outcomes through pay-for-performance plans. Furthermore, to enhance patient health and medical efficiency, the NHI launched its Taiwan Diagnosis Related Groups (Tw-DRGs) program on January 1, 2010, followed by a second stage of the program, which has been in effect since July 2014.
     To ensure that the quality and scope of the care provided by medical institutions is not affected by the implementation of the global budget payment system, while negotiating global medical expense budgets, the NHIA also drafts quality assurance programs. These quality assurance programs for global budget sectors include medical services quality satisfaction surveys, complaints and reported case handling mechanisms, and insured care accessibility monitoring. The NHIA has also determined clinical services guidelines for professional treatment quality, drafted standards for professional review and case histories, established a hospital and clinic assistance system and medical services quality indicators, and maintained the transparency of quality information by posting relevant information on the NHIA website as a reference helping hospitals and clinics to continue to improve their medical quality.