Li Po-Chang, Director General of the National Health Insurance Administration (NHIA) of Ministry of Health and Welfare, indicated that the concept of a universal value for human rights to medical care has increased in popularity and received a high level of attention from human rights groups at home and abroad. Because the national health insurance program implemented in Taiwan is aimed at boosting the health of citizens and granting them a fair right to medical care, the question of whether or not National Health Insurance (NHI) insured with overdue NHI premium payments should have their NHI cards locked is of continued concern to all sectors of society. In recent years, the NHIA has continued promoting assistance measures for economically disadvantaged groups with overdue NHI premium payments. The NHIA has gradually adopted an approach that severs the relationship between overdue premium payments and rights to medical care (hereafter referred to as "card unlocking"). Such an approach has reduced the number of NHI policy holders with overdue payments and locked cards from 693,000 in 2007 to approximately 42,000 in April 2016. In addition, 20 years of statistics collected by the NHIA demonstrate that the premium collection rate for group insurance applicants and beneficiaries has maintained a level of 98.8% or more, suggesting that the people have a high degree of acceptance of and support for payment of NHI premiums. Only an extremely small number of them are non-economically disadvantaged insured with overdue premium payments. Furthermore, the NHIA has a statutory debt collection mechanism for individuals with overdue premium payments. Therefore, as the last mile to realizing the comprehensive protection of people's right to medical care, we announce the full unlocking of NHI cards, while at the same time strengthening collections for overdue payment, in order to establish the universal value of the right to medical care and move the NHI program toward an entirely new milestone.

Based on its experience in helping financially disadvantaged people eliminate their barrier to medical care, the NHIA further states that even though disadvantaged people with pending premium payments are exempt from locking and are informed by NHIA through official notifications, if these people still mistake themselves as having had their cards locked owing to overdue payments, then despite the NHIA's assistance measures for overdue premium payments (e.g., installment payment, loans from relief funds, referral to charity groups, and emergency medical protection measures), when disadvantaged people have not sought assistance, this might still lead to regrettably delayed medical care when financially disadvantaged people are concerned about their suspended status.

Comprehensive Measures for the Unlocking of Cards

Director General Li Po-Chang stressed that the unlocking of suspended NHI services does not mean that overdue debts have been erased. To prevent intentional refusal of NHI premium payment, the NHIA will not only send reminders to those with pending payments and refer their cases on for handling by the Administrative Enforcement Agency, but also strengthen payment reminder mechanisms as follows:

1.There will be checking against the NHI database on a monthly basis, such that once those with pending payment insure themselves as employees, the Administrative Enforcement Agency will be notified and a portion of their salary will be deducted to compensate for arrears.

2.In accordance with the Second-generation National Health Insurance Act, for those who receive interest, stock dividends, and rental income, the premium withholder shall, on a monthly basis, submit detailed data on deduction of supplementary premiums to the NHIA and notify the Administrative Enforcement Agency to appropriate a portion of their savings, interest, stocks, or rental income as compensation for their overdue premium payment.

3.Regarding those who are unable to pay their premiums, after they have received a reminder for overdue payment, and obtained debt certification from the Administrative Enforcement Agency after finding that they had no salary, stock, or savings from which to deduct as payment for their debt, they shall still be subject to annual investigation within the enforcement period (10 years). If found to be in possession of income or properties, they shall again be referred to the Administrative Enforcement Agency for handling.

Comprehensive Unlocking Does Not Affect NHI Finances

At present, delinkage of overdue premium payment from the right to medical care has already progressively been put in place. As of April 2016, the number of NHI policy holders with locked cards was 42,000, with overdue payments for the most recent five years totaling roughly NT$2 billion, an annual average of NT$400 million. The NHIA will continue to actively issue payment reminders and submit overdue cases to the Administrative Enforcement Agency. Overdue debts have not been erased. Based on an annual premium income of more than NT$570 billion, comprehensive card unlocking will not have an impact on NHI finance and operations.

NHIA Director General Li indicated that unlocking of NHI cards symbolizes a new high point for the right to medical care. The benefit is not to the current 42,000 people whom outsiders call those with locked cards; instead, it is that only by abolishing the card locking system can we remove the fetters imposed on financially disadvantaged people who fear to seek medical care because of overdue premium payments. This way, the government can implement care for the disadvantaged and fulfill its mission of protecting all citizens' rights to medical care.