Starting January 1, 2026, the National Health Insurance Administration (NHIA) has launched three major initiatives: a Hyperlipidemia Healthcare Reimbursement Improvement Project, proton therapy coverage for pediatric cancer patients, and 60% to 100% add-on payments for emergency major trauma surgeries or treatments. These initiatives, with a total budget of NT$370 million, are expected to benefit an estimated 34,000 patients annually.
According to the Taiwan Society of Cardiology, atherosclerotic cardiovascular disease (ASCVD) is one of the top ten leading causes of death in Taiwan, with heart disease ranked second and cerebrovascular disease fourth. Elevated low-density lipoprotein cholesterol (LDL-C) is a major risk factor for ASCVD. To reduce this risk and improve public health, the NHIA has implemented the ASCVD care model and LDL-C treatment targets.
Director General Lian-Yu Chen emphasized that the NHIA is proactively implementing a Pay-for-Performance program. Since 2023, the NHIA has partnered with nine major medical associations to implement the “NHI Hyperlipidemia Healthcare Reimbursement Improvement Project”. The initiative includes the establishment of the ASCVD Risk Classification system and the “Consensus on the Clinical Pathway for Blood Cholesterol Management”. Hospitals are encouraged to follow the clinical pathway for the care and follow-up of patients at “extremely high” and “very high” risk. The program offers case management fees ranging from 500 to 2,000 points and a referral fee of 1,000 points. The initiative, effective as of January 1, 2026, is expected to benefit around 34,000 patients annually, with an allocation of 113 million points.
The Taiwan Society for Therapeutic Radiology and Oncology states that, based on international clinical evidence, proton therapy is an advanced radiation treatment technology that utilizes high-energy proton beams to destroy tumor cells with greater precision, minimizing damage to surrounding healthy tissues. Compared to conventional radiation treatments, proton therapy has fewer side effects and reduces the risk of secondary cancer. For pediatric cancer patients, proton therapy offers higher safety and better prognosis.
Director General Chen noted that proton therapy for pediatric cancer treatment will take priority in reimbursement, with three levels of coverage based on the radiation dosage: low-dose (676,000 points), medium-dose (1.03 million points), and high-dose (1.26 million points). This initiative is expected to benefit approximately 100 children annually, with the NHIA allocating 105 million points.
Director General Lian-Yu Chen also discussed another newly implemented measure to enhance emergency service capacity and resilience in treating major trauma cases. The NHIA has introduced a 100% add-on payment for major trauma patients receiving specific services, such as radiation therapy, treatment procedures, surgeries, and anesthesia, within 2 hours and 60% within 2 to 4 hours of arriving at the emergency room. This initiative is expected to allocate 154 million points. Secretary General Ling-Wei Kuo of the Formosa Association for the Surgery of Trauma emphasized that the additional payments would be given priority to frontline healthcare professionals.
As medical technology evolves, the NHIA will continue to allocate budgets and collaborate with experts to introduce advanced treatments, enhancing healthcare quality, and public health toward a “Healthy Taiwan”.