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Under the NHI compulsory enrollment system, it is inevitable that some low-income families and economically-disadvantaged groups may not be able to afford health insurance premiums. To ensure that all citizens have access to care, the NHIA provides many assistance measures aimed at maintaining a strong safety net and the spirit of mutual assistance. The NHIA consequently offers numerous premium payment assistance measures aimed at patients with catastrophic illnesses, such as cancer, kidney diseases requiring dialysis, hemophilia, and mental illness, and economically-disadvantaged citizens. Furthermore, the NHIA also provides medical and economic assistance to people living in remote areas or suffering from rare or critical illnesses. Current assistance measures include premium subsidies, relief loans, and installment payment plans.

Care for Medically Vulnerable Groups

Introduced by the NHIA in 2002, the program for providing dental services to persons with disabilities offers higher reimbursements to encourage dentists to provide dental care to patients with congenital cleft lips and palate, and other groups with specific disabilities. The NHIA eased regulations in 2006 to allow local dentist associations or groups to establish dental teams to provide regular services to organizations devoted to caring for people with disabilities. The teams can provide mobile dental services to psychiatric hospitals without dental departments and special education schools with special needs. Since July 1, 2011, dentists from the teams have provided in-home dental services to persons with designated disabilities who meet residential care criteria. On January 1, 2013, the teams began providing dental care to bedridden patients at organizations caring for the disabled, and on January 1, 2014, the teams began providing services at government-registered organizations caring for developmentally delayed children. The teams’ service scope was further extended to bedridden patients at elderly care facilities under the Ministry of Health and Welfare on January 1, 2015. On January 1, 2020, services for preparation for being discharged and dental service in nursing home selected by Department of Nursing and Healthcare, Ministry of Health and Welfare are available. On January, 2021, dental services for people with moderate moving functional limitation due to brain and spine injury are available.

The 30 catastrophic illnesses announced by the NHIA include cancer, chronic mental illness, end stage renal failure, and congenital conditions, all of which are very costly to treat. Insured individuals with a catastrophic illness card are exempt from copayments when obtaining treatment of these conditions. As of the end of December 2020, a total of more than 970,000 catastrophic illness cards had been issued (to over 911,000 people, who accounted for 3.8% of all insured). In 2020, the cost of treating catastrophic illnesses totaled approximately NT$227.4 billion, and accounted for 28.7% of all NHI medical expenditures. Roughly NT$74.4 billion in NHI expenditures goes for the purchase of drugs needed to treat catastrophic illnesses, and this amount is nearly 34% of the NHI system’s total medication expenditures. The high level of spending on the treatment of catastrophic illnesses reveals the tremendous assistance that the NHI system provides to these individuals.

Individuals with rare diseases classified as catastrophic illnesses are exempt from copayments when being treated for their condition. The Ministry of Health and Welfare currently recognizes 226 types of rare diseases, and had issued 11,771 rare disease verification cards as of the end of December 2020. Drug expenditures for the treatment of rare diseases totaled approximately NT$6.66 billion in 2020. In order to provide necessary care to patients with rare diseases and ease their medical care burdens, reimbursement standards for all medications designated for use in the treatment of rare diseases must be promptly included in the NHI Drug List and Fee Schedule.

Patients with multiple chronic conditions consume the largest share of resources in Taiwan’s healthcare system. With the aging of Taiwan’s population, the prevalence of multiple chronic conditions has been increasing steadily, and the care of these individuals is becoming an important issue. To ensure that such patients obtain integrated care services, and avoid redundant or inappropriate medications, examinations and treatment, the NHIA initiated the “Hospital Integrated Care Program”on December 1, 2009. Patients participating in this program have lower copayments and registration fees, reduced visit and transportation time, and increased care safety and quality.

According Article 43 and 60 of the Enforcement Rules of the National Health Insurance Act, where a beneficiary receives outpatient care service, emergency care services or home health care service in a resource depletion area, the self-bearing amount may be reduced by 20%. In addition, the NHIA has also implemented the following plans in order to enhance medical services in remote areas or areas deficient of medical resources.