The World Health Organization defines palliative care as taking care of patients with life threatening illnesses with the goal of improving the quality of life of patients and their families. The Bureau of National Health Insurance (BNHI) spares no effort to improve the quality of palliative care services in the hope that people who require palliative care services will receive good care.
The BNHI started palliative home care services on a trial basis in 1996. In 2000 when the Legislative Yuan passed the third reading of "Hospice Palliative Care Act" to open up a new page for terminally ill patients’ right to self-determination regarding medical care, the BNHI started the trial implementation of inpatient palliative care services to promote the holistic nature of the treatment. Initially, terminally ill cancer patients were the target population for palliative care; then in 2003, patients with amyotrophic lateral sclerosis were included. Now there are 37 hospitals nationwide with a total of 541 palliative care beds to provide inpatient palliative care services under National Health Insurance (NHI). The NHI expenditure on inpatient palliative care was NT$ 542 million in 2008, with a total of 64 institutions providing palliative home care services under current NHI. Annual NHI expenditure is about NT$ 36 million.
The status of palliative care utilization by our people showed that over the past three years, nearly 3,000 people each year had used palliative home care services before they passed away; the ratio of the number of users to the number of deaths was raised from 0.18% in 1996 to 2.09% in 2008. As for inpatient palliative care, the number of people who had used palliative care beds before passing away increased from 871 in 2000 to 6,848 in 2008; the ratio of the number of users to the number of deaths increased from 0.70% in 2000 to 4.81% in 2008.
Therefore, since September 1st, 2009, in order to expand the scope of care and promote understanding of palliative care, the BNHI has officially included the original trial implementation projects (inpatient palliative care and palliative home care) in the regular NHI payment, and terminally ill patients in eight newly added categories who meet the admission criteria of the palliative care ward after being professionally diagnosed by physicians are also included in the target population; the eight categories are patients with "senile and presenile organic psychotic conditions", "other cerebral degenerations", "heart failure", "chronic airway obstruction, not elsewhere classified", "other diseases of the lung", "chronic liver disease and cirrhosis", "acute renal failure, unspecified" and "chronic renal failure and renal failure, unspecified". As result, terminally ill patients who wish to receive palliative medical care services may be able to under NHI in accordance with their needs. Thus Taiwan will keep up with the global trend and remain in line with the WHO’s concepts, achieving another milestone in our nation’s palliative care.
The palliative home care services offered by the BNHI include regular visits by physicians, nurses and social workers, as well as providing control and relief of patients’ pain and other symptoms. In order for patients at home or institutions to immediately obtain professional consulting service from health care personnel, service agencies also provide a 24-hour telephone advice line service for public inquiries in addition to regular visits.