The second generation NHI is to come into force on January 1, 2013 alongside the National Health Insurance Referral Guidelines. Highlights of the Guidelines are given below:

1. Referrals shall meet the requirements of the Medical Care Act and the needs of medical care. Healthcare facilities help refer patients to appropriate contract hospitals and clinics in accordance with their condition. Step by step referrals are unnecessary. Patients in stable condition are referred to appropriate healthcare facilities for subsequent follow-up and treatment.

2. Contract hospitals and clinics shall establish bilateral referral mechanisms with other contract hospitals and clinics to boost cross-facility collaboration and keep certain openings for referred patients if necessary.

3. It is specified that contract hospitals and clinics shall establish referral counters and provide patients requiring referrals with appropriate medical arrangements, including contacting the hospital/clinic, the appointment date, name of the medical department/division, and registration assistance.

4. It is specified that contract healthcare facilities shall issue the referral form to streamline the referral process and make related contacts and arrangements for beneficiaries based on their professional judgment. In addition, referrals of beneficiaries are limited to contract hospitals/clinics specified in the referral form in order to minimize meaningless and unnecessary referrals.

Referrals done in accordance with these Guidelines are entitled to less co-payment than walk-ins to large hospitals. This is meant to encourage people to go to small clinics for mild illnesses and only visit large hospitals for serious illnesses. In accordance with existing requirements, co-payment is NT$210 for referrals and NT$360 for non-referrals to medical centers and NT$140 for referrals and NT$240 for non-referrals to regional hospitals. As indicated in the requirements, the first visits within six weeks after outpatient surgeries, emergency room surgeries, and labor and within one month after discharge from a hospital are also considered as referrals and the co-payment may be collected in accordance with referral criteria.

In the event that NHI contract hospitals and clinics fail to refer patients in accordance with these Guidelines and do not make corrections by a given deadline or are in violation of the requirements in Article 73 of the Medical Care Act for refusing to provide referrals without reasons, they will get points as indicated in the "Contract and Management Regulations Regarding National Health Insurance Affiliate Medical Service Institutions."

The referral system for the second generation NHI is smoother than the existing referral process and meets the criteria of professional arrangements so that patients will feel the change, and it significantly improves unassisted referrals. It will help consolidate classified referrals. Despite the fact that there is no restriction for patients to seek treatment at large hospitals and that it is not mandatory for patients with stable condition to be referred to an appropriate hospital for follow-up and treatment, the BNHI encourages that people find a trustworthy family doctor at a nearby clinic or community hospital that is familiar with their long-term medical history to help them with professional referrals so that patients can find the right doctor and the right department and save waiting time and cost of medical care. In fact, direct walk-ins to medical centers to see a doctor without referrals often result in the situation where the doctor sees the patient for too short of a period of time and that the doctor is unfamiliar with the patient's medical history. This is at risk of superficial treatment that does not get to the root cause of the illness. It is advised that people value medical resources and work together to have a sustainable NHI.

Note: Please click on the following link for the National Health Insurance Referral Guidelines.