In response to public complaints about certain obstetrics and gynecology clinics charging tens of thousands of dollars for performing extraperitoneal Cesarean section procedures, the National Health Insurance Administration (NHIA) would like to provide the following clarification:
The NHIA states that the Cesarean section (C-section) procedure has been included in the NHI package since its establishment in 1995. Relevant C-section payment regulations have been established to include a total of 22 indications, and the bundled payment method is utilized. Clinical physicians should use their expertise to determine whether the conditions of the pregnancy or the fetus are indications for C-section procedures. If so, the NHI-contracted medical facilities should follow the procedure and declare the medical treatment fee, ranging from 30,000 to 50,000 points (depending on whether there were complications during pregnancy). If a patient requests a C-section procedure without relevant indications, the NHI will still cover a portion of the C-section fees, approximately 15,000 points.
To understand the actual implementation in clinical practices, the NHIA conducted inquiries with the Taiwan Association of Obstetrics and Gynecology and the Taiwan Society of Perinatology. Both organizations agreed that the indications and payment for extraperitoneal C-section should be the same as those for intraperitoneal C-section (i.e., the conventional C-section). Additionally, the NHIA convened a consultation meeting with various medical services experts on October 4, 2023 and all attendees agreed that the current NHI package covers all C-section methods.
The NHIA specifies that, according to Article 12-1 of the Physicians Act, when diagnosing and treating patients, physicians must inform the patient or the patient’s family of the status of the disease, treatment, and prognosis. Moreover, Article 21 of the Medical Care Act stipulates that standards for medical fees charged by medical care institution should be determined by the municipal or county/city authorities. Therefore, obstetrical physicians should explain relevant details to patients entering the parturition stage and acquire their consent before performing a C-section procedure. When experiencing unethical billing for items covered by the NHI package, you may place a complain to the local NHIA division office of the clinic or hospital, attaching the receipt of non-NHI item payment as supporting documentation. Finally, the NHIA urges the Taiwan Association of Obstetrics and Gynecology to inform its members about relevant regulations to prevent violations of people’s rights to medical treatment.