The National Health Insurance Administration (NHIA) implemented adjustments to the copayment for health services starting July 1, 2023, to promote a hierarchical health care system and guide the public toward appropriate healthcare utilization. Under the new policy, the maximum copayment for medications prescribed at medical centers or regional hospitals has been increased from NT$200 to NT$300. For chronic illness refill prescriptions issued by hospitals, the copayment for the first dispensation is calculated as for regular prescriptions, while subsequent dispensations remain exempt from copayments. Additionally, copayments for emergency department visits have been raised to NT$750 at medical centers and NT$400 at regional hospitals.

According to the NHIA, the preliminary outcomes observed one year after the implementation of the revised copayment policy are as follows:

1. Facilitating Hierarchical Health Care: 
   The proportion of outpatient visits at primary care facilities increased from 70.17% to 70.39%, a rise of 0.22%. The rate of chronic disease patients receiving care at primary care clinics increased from 38.85% to 43.46%, an improvement of 4.61%. 
2. Reducing Emergency Room Congestion: 
   The proportion of mild cases (triage levels 4 and 5) at emergency departments across at all hospital levels decreased compared to the year before the pandemic, with reductions ranging from 2.27% to 6.43%. 
3. Minimizing Medication Duplication: 
   The average medication cost for chronic illness refill prescriptions decreased from NT$884 in 2022 to NT$842 in 2024. 
4. Enhancing Payment Equity and Financial Sustainability: 
   The copayment as a share of total health expenditures increased across all hospital levels: from 13.9% to 16.1% for medical centers, 10.4% to 12.2% for regional hospitals, and 5.6% to 6.7% for district hospitals, while local clinics remained unchanged. These adjustments contributed an additional NT$5.27 billion to NHI revenues. 
5. Ensuring the Healthcare of Vulnerable Populations: 
   Patients with catastrophic illnesses and low-income households remain exempt from copayments. Access to care for middle- and low-income households and persons with disabilities has not been affected.