To allow sufficient time for primary-care medical personnel to maintain their physical fitness, attend job-related trainings, and improve service quality, after implementing the five-day work week for physicians, the Taiwan Medical Association has proposed a revised calculation method for NHI payout standards for reasonable outpatient volumes. The original requirement of 25 days per month of service (inclusive) or above to qualify for a full-month payment has now been amended to 22 days. The pilot projects for the relevant supplementary measures shall be rolled out nation-wide after confirmation at the meeting of the Committee of Global Budgeting for Primary Care Services on November 9, 2011.

The proposed changes on calculating the reasonable outpatient volumes have been discussed at the meeting of the Committee of Global Budgeting for Primary Care Services on August 24, 2011. The conclusions are as follows: The Taiwan Medical Association will propose specific supplementary measures to protect the rights of the NHI participants to receive medical care. The Association will first further discuss the issues and communicate with representatives of consumers and premium payers to achieve consensus before implementing these measures.In September 2011, the Taiwan Medical Association submitted a letter with its proposals for the supplementary measures. Considering the lack of specific monitoring indices in the original proposal, the Bureau requested that the Association refine the proposal and recommend supplementary measures for nation-wide enforcement. On November 4, 2011, the Bureau further organized a preparatory meeting among representatives from the Taiwan Medical Association, the Taiwan Healthcare Reform Foundation, the Committee of Global Budgeting for Primary Care Services, consumers, and the NHI Medical Expenditure Negotiation Committee, as well as scholars and experts in the field. The conclusions are as follows:

The pilot projects shall be implemented on a conditional basis, taking into account the Public's need for medical care on holidays.
 
In view of the increased need for medical services in autumn, winter, and during the Chinese New Year, as well as the time required for preparation, the pilot projects shall be started in April, 2012 based on a unified national approach.
 
The following supplementary measures shall be implemented in addition to those proposed by the Taiwan Medical Association (e.g., promotional activities and registration of service hours, etc.):

(1).All clinics are required to announce, two weeks in advance, the holidays and non-working days for the following month in a prominent location in the clinic. The medical associations of the city or the county should compile a rotation schedule for Saturdays and Sundays, which should be publicized on the websites of the Association and the Bureau.
(2).Each NHI region should establish a 24-hour call center for the public to check the availability of weekend medical services in their neighborhood. The telephone number of the call centers should be publicized on the clinics' websites and in their announcements for service suspension, enabling people to check accordingly.
(3).The above tasks should be completed before the commencement of the pilot project.

Monitoring Indices and Methodologies:-

(1).Monitoring indices shall be established to evaluate the medical services provided on Saturdays and Sundays for each city or county (according to the administrative districts before the merger in 2010). During the pilot period, the weekend medical services shall be monitored on a monthly basis. Any city or county that fails to achieve the monitoring indices for three consecutive months, or four months on a cumulative basis, shall be required to withdraw from the pilot project.
(2).A general review shall be conducted one year after the commencement of the pilot projects.

The above conclusions shall be discussed further and confirmed at the meeting of the Committee of Global Budgeting for Primary Care Services on November 9.

The Bureau shall take follow-up actions pursuant to the resolutions made at the meeting of the Committee of Global Budgeting for Primary Care Services, and effectively implement monitoring measures to protect the public's right to receive medical services.