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The Diary of the National Health Insurance Reform Series (Edition 1.0 to 2.0 and 3.0) delineate the efforts of the NHI sustainable development since 2016.

Taiwan's NHI reform since 2016 has been described in detail in the book Marching to the Cloud: Win-Win for Patients and Doctors, the Diary of the NHI Reform. Edition 3.0 is set to be released in October 2022. Edition 1.0, published in May 2019, shared the views about Taiwan's NHI system and reflections on NHI as well as policy implementation. Edition 2.0, published in April 2021, elaborated the basic concepts of NHI and shared both of problems and solutions with the public. This latest edition, 3.0 is comprised of "Concepts," "the Real World," and "Reform” three sections. The contents include past issues and future challenges for developing sustainable NHI.

In recent years, the implementation of referral system and the introduction of information technology into the NHI have played an important role in the fight against the pandemic. The application of information technology in health services has three phases. The first is deployment of optical fiber that gives medical institutions channels for transmission of information, like highways connecting many medical institutions. In the second phase, the NHI MediCloud is used to serve as an interface for sharing among medical institutions. Physicians can use the system's cloud medication records to learn about people's medication usage, thus reducing repeated medications and repeated tests. This mechanism is based on data uploads and sharing between healthcare providers. This system has won numerous awards and been supported by the health professionals. The third phase is going to build the “NHI Cloud” based on the concept of the “cloud market” for the NHIA, medical institutions, and the public. Medical institutions are encouraged to use cloud-based health information systems and also to integrate video consultations and electronic payments, making the interactions between healthcare providers and patients smoother and more convenient. And many health care start-ups can also provide medical institutions and the public with additional services in the “cloud market.”

Meanwhile, My Health Bank surpassed 103,000 users at the end of December 2015. On June 29, 2022, this number skyrocketed to over 10 million. My Health Bank is now the best medium for providing public services as well as policy promotion.

NHI, in pursuit of excellence, continues to move forward. There were five major aspects in need of reform. The first one is to perform a full-scale review and revision of the NHI fee schedule, revising inappropriate categorizations and definitions, aligning with the real medical costs and making the estimates of the NHI Global Budget much closer to actual expenditures.

Secondly, encourage medical institutions to re-file their medical claims of their own accord instead of denying their claims and punishment, ending fraudulent behavior. The NHIA takes zero tolerance towards false and inflated reports, encouraging medical institutions return claims of their own accord.

Thirdly, the role of the medical centers, regional, and district hospitals shall be definite, and they shall be subsided in order to fulfill their assignments. In addition, hospitals in remote areas shall be provided with certain guaranteed subsidies.

Fourthly, electronic prescribing shall be considered. Taking advantage of the NHIA's medical information network system, a digital prescription system could be implemented. And combined with using the telemedicine platform, equipped with MediCloud, Virtual NHI Card, and identification code for medical visits, the utilization of Taiwan’s health information will be further advanced.

Lastly, in order to reform the pharmaceutical reimbursement system and enhance to the international competitiveness of Taiwan-manufactured pharmaceuticals, evidence-based assessments of efficacy data should be applied to develop new drug reimbursement standards. As for accelerating coverage of new drugs in NHI, the copayment adjustments should be implemented. Healthcare providers and the public should reflect over their healthcare behaviors to avoid unnecessary medications. If we have sufficient financial resources, new drugs, new medical devices, and new treatments can be covered by NHI at an accelerated rate.

It will benefit the entire population that referral systems and copayment are well-implemented, and unnecessary medical expenses are reduced on the premise of respecting the medical expertise, resources are properly allocated to new drugs, new technologies and medical professionals.

The Diary of the NHI Reform series is for medical practitioners, health insurance scholars and experts, legal professionals, and people concerned about health insurance issues from all over the world. This series offers people the opportunity to better understand the mechanisms by which people's health is protected and the health right is secured.

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