The NHI global budget payment system has been in place for many years, stabilizing the provision of medical services and healthcare in Taiwan. In response to new medical technologies and challenges posed by an aging population, President Lai convened the Healthy Taiwan Forum and proposed pertinent medical policies, emphasizing the sustainable development of the NHI program. In accordance with these goals, the Ministry of Health and Welfare (MOHW) has planned to implement the following measures to reform the NHI:
- Continuously expanding resource allocation to maintain an appropriate growth rate of the global budget, items currently covered under the global budget such as long-term care, public health, preventive healthcare, information infrastructure, nursing subsidies, and provisional listing for new cancer drugs will be transitioned to the general budget. The funds originally allocated to these items will remain within the global budget, aimed at enhancing NHI points and improving healthcare quality.
- To accurately reflect actual medical costs and recognize the efforts of clinical personnel, the National Health Insurance Administration (NHIA) established the NHI Reimbursement Scheme Proportionality Evaluation and Planning Expert Committee in June 2024. The Committee will engage in ongoing discussions with relevant professional groups and medical specialist associations. Currently, the main priorities include expanding the medical workforce and enhancing reimbursements for urgent and critical cases. The aim is to improve compensation for medical personnel to stabilize healthcare capacity.
- To rationalize the allocation of healthcare resources, subsidies will be provided to "lighthouse hospitals" in resource-scarce mountainous and island areas. This support aims to secure their income or NHI points, ensuring the continuity of local healthcare resources.
- Planning a tens of billions cancer drug fund to increase public access to new cancer medications while avoiding crowding out the existing NHI resources. Subsequent annual reviews will ensure ongoing monitoring of reimbursements.
To ensure effective use of NHI resources, improve NHI effectiveness, and reduce unnecessary expenses, the NHIA is proactively implementing the following policies: Continuous implementation of the hierarchy of medical care and the family physician system that prompts patients with low-risk or stable chronic diseases to seek care from local facilities and allows regional or higher level hospitals to reserve their capacity for patients with high risk or critical conditions to achieve reasonable allocation of healthcare resources; Optimizing the NHI MediCloud system to minimize repeated prescriptions, examinations, and tests; Enhancing healthcare service inspection to impede improper growth; Conducting reimbursement scheme reviews for drugs and medical materials on a rolling basis; and Conducting copayment system reviews.
The NHI global budget is an investment in the health of the entire population and a critical national social insurance system. Ensuring a fair value for NHI points is a shared expectation, but it requires careful consideration and comprehensive planning of complementary measures. Only through this approach can the global budget achieve moderate growth, ensure reasonable resource allocation, provide healthcare personnel with fair compensation, guarantee quality medical care for the public, and sustain the long-term viability of the NHI program.