~from Mr. Chih-Liang Yaung, Minister of Health

I. Expressing Thanks to President Ma for His Support of the Second-Generation National Health Insurance (NHI) Reform

• When President Ma Ying-jeou received representatives from the medical field on July 16, he pushed hard for second generation National Health Insurance (NHI). He described the NHI system as providing “the best care one could get for such a low price – it is not easy to find anything comparable in other countries.” President Ma urged the Legislative Yuan to complete its legislation as soon as possible. He also maintained that the current NHI system is in dire need of a complete overhaul. “[The NHI] will collapse if not changed,” he stressed.
• According to Mr. Ma, the new NHI system will be a system of “quality, efficiency, and fairness.” Second-generation NHI, including its prompt implementation, will have a historically positive impact on the development of the Taiwanese health care system.

II. You Were a Key Component in the Amendment Process!

We greatly appreciate the assistance provided by legislators, especially members of the Health, Environment, and Social Welfare Committee. The tremendous amount of legislative resources committed during the amendment process, including the Q&A session, comprehensive discussion, and eight article-by-article deliberations, have been unprecedented.

• In the beginning, Ms. Yang Li-huan, the chairperson, opened the gates to all versions of amendment submissions, allowing every legislator to express his or her own stance on the issues. She also held four public hearings to actively listen to voices from people of all fields.
• Ms. Ho Tsai-feng, the second chairperson, not only made herself as helpful as possible during the meeting procedures, but also actively engaged herself in communications and negotiations with unions and labor representatives. Her efforts aided in resolving their potential misunderstandings of the legislation.
• Mr. Lin Yi-shih, Director of the KMT Central Policy Committee, and Mr. Lin Hung-chih, the Chief Secretary of the KMT Legislative Caucus, generously offered their help to organize four party policy meetings so that the majority of disagreements within the KMT could be resolved in advance.
• We would also like to extend our thanks to all KMT legislators sitting on the Health, Environment, and Social Welfare Committee for their participation in each and every meeting. Their joint efforts to safeguard the welfare and interests of the public have advanced the second-generation NHI legislation closer to a legislative consensus.
• Due thanks must also be given to the DPP legislators. Despite their absence in the provisional meeting, a number of Legislators, including Ms. Huang Sue-ying, Ms. Tien Chiu-Chin, Ms. Chen Chiech-Ju, Mr. Huang Jen-zhu, Mr. Liu Chien-Kuo, Mr. Twu Shiing-Jer, and Ms. Chen Ying, had offered their perspectives and recommendations regarding the second-generation NHI amendment. Their opinions in preceding discussions had also been collected and incorporated as much as possible by the Department of Health into the legislative draft. For example, in light of the DPP’s demand for a 35% minimum government share, the current amendment version recommends that the government’s share shall not be lower than 36%. For those who worry that the 1/3 share by premium payer representatives is too low, please note that the current amended version has elevated that share to no lower than 1/2. Therefore, we are pleading for DPP legislators to return to the negotiating table. “The NHI issue has nothing to do with which political party you belong to, it's all the same!” It would be in the public’s best interest if you could all please abandon the political turmoil and retrieve the determination necessary to support NHI reform and provide the best-quality of care for the people. We look forward to seeing you in the consultation meeting and resuming our discussion.
• Our thanks also of course go out to private-sector organizations, the media, and the public, who have all been deeply involved in the second-generation NHI debate. This is not only a time for the Legislative Yuan to carry out the law-amending process, but is also chance for every individual to be “NHI-literate.” The wide media attention and discussions surrounding NHI reform provide the perfect educational opportunity. (However, both right and wrong information has been present in the news reports. It necessitates additional efforts by the Department of Health to continue to propagate correct information about the NHI.)

III. The Dawn of Reform is on the Horizon

One may wonder what exactly is being reformed with second-generation NHI, and what the benefits will be. I hereby present to you the observatory report published by the Taiwan Healthcare Reform Foundation (THRF). This report contains a news release by the THRF on June 3, titled “Health, Environment, and Social Welfare Committee of the Legislative Yuan Passes the Inspiring Amendment of Second-Generation NHI at the First Review.” According to the report, the amendment brings great improvements in the public’s healthcare benefits, as follows:

• Relaxation of the card-locking regulation. Active referral to social welfare resources where care and assistance are offered.
• Medical payment negotiation meetings, drug payment negotiation meetings, and total payment commissioners’ meetings shall be convened by the three principles of “equal negotiation,” “avoiding conflicts of interest,” and “transparency of meeting records.” This will prevent criticism of ‘black-box meetings’ which have occurred in the past.
• A maximum registration fee of NT$150 for a hospital visit has been stipulated in the additional resolution to protect public interests.
• There will be a boost in the number of NHI beds. Contracted medical care institutions will be required to make public the usage of their NHI beds on a daily basis. The Bureau of National Health Insurance (BNHI) will provide a monthly public report on the ratio of NHI beds and make quarterly inspections. A penalty of NT$10,000 to NT$50,000 per shortage of NHI bed, along with orders to improve, will fall on those without a sufficient number of NHI beds.
• After treating a patient, a prescription “should” be given by the contracted medical care institution.
• Any contracted medical care institutions that receive an insurance payment exceeding a certain amount shall submit to the BNHI and publicize a NHI-related financial report that is certified by an accountant or reviewed by a reviewing agency.

IV. The NHI Reform Cannot Be Half-Baked

After being first reviewed by the Health, Environment, and Social Welfare Committee on May 20, 26 of the initial 99 articles proposed by the Department of Health were retained. In fact, as the DOH has put great efforts into incorporating suggestions from the KMT and DPP legislators and private-sector organizations, there should be few articles that arouse any major controversy.

Drawing an example from the premium rates, which most people are especially concerned about, the latest version of the amendment has stipulated that the government’s share shall not be lower than 36%, and the people’s share shall not exceed 3.5%. Debates over other articles of the amendment remain within a range solvable by political debate and discussion.

In their joint press conference, the Civilian NHI Oversight Alliance and some healthcare organizations expressed their views in opposition to the passing of the National Health Insurance Act during the provisional meeting. What is difficult to comprehend is that, if there was time, these groups should have also established consensus among themselves through self-motivated meetings and discussions to facilitate quicker passage of the amendment.

The DOH is open to all rational comments on the amendment, but will not be hindered by excuses such as “it is moving too fast” or “there is a lack of discussion,” because they will wipe out all of the effort of dedicated individuals who have participated in discussions thus far and shared their wisdom.

****  Table of Disputed Articles of the National Health Insurance Act ****

V. Instead of Moving Too Fast, the Second-generation NHI is Actually Moving Too Slow

Discussions about second-generation NHI have lasted for more than ten years. The reform is a social engineering project that crosses political party boundaries and three presidential terms and is not just another piece of today’s news. The problem now is “too much talk,” while what’s needed most is a “just-do-it” attitude. Otherwise, this issue will linger on for another hundred years without any results.

• 9/2000-4/2001 The Department of Health established the “NHI Checkup Team”
• 4/4/2001-1/4/2005 The Executive Yuan established the “Second-Generation NHI Planning Team.” Four years after embarking on a four-year process which included discussions, interviews, research, and planning, the team finally submitted suggestions that would guide the second-generation NHI reform.
• 5/3/2006 The DPP government proposed the National Health Insurance Act amendment.
• 4/8/2010 The KMT government withdrew its original proposal and re-submitted the National Health Insurance Act amendment.

When we first submitted the initial proposal for the National Health Insurance Act amendment, I was mocked and referred to as being like Don Quixote. However, after giving it some thought, I have become determined to follow the example of the legendary Chinese hero “Zhou Chu,” who was dedicated to eliminating “the three villains” only later to realize that he himself was one of the last three. This is my situation. I think that the impasse of the bill is due to my lack of communication, as well as an insufficient amount of effort put in by the DOH’s NHI team. During this one-month period while the provisional meeting is being held, I urge all of my staff members to communicate with every legislator on every detail of the bill without being daunted by any potential refusals or setbacks.

I hereby sincerely ask legislators of the DPP to return to the Legislative Yuan and pick up where we left off on the bill review. With the second-generation NHI bill at a standstill, NHI finances will continue to worsen, people whose NHI cards are locked will not receive their needed care, authorities cannot request hospitals to provide NHI beds and mandate them to publicize their financial reports, and all of our previous efforts shall be for naught. Discussions and debates centered on the reform bill during the next legislative session will be all the more difficult due to the upcoming election. Therefore, I emphasize that it’s time to “start the count down for second-generation NHI and seize the opportunity to reform.” We are all standing at a critical juncture in history. Your will for justice is going to join forces with others and establish a brighter future for the health and welfare of the public.