National Health Insurance Administration Ministy of Health and Welfare

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NHI Measures of Strengthening the Referral System and Related Packages

  In light of the call from the general public and the medical community for reform of National Health Insurance and in order to further improve the soundness of National Health Insurance, the NHIA (National Health Insurance Administration) plans to strengthen the referral system. Having collected opinions through public hearings and the Social Welfare and Environmental Hygiene Committee of the Legislative Yuan and from experts and scholars, six major strategies and related packages have been established for the time being, including (1) reinforcing the capability of primary care to provide required service, (2) providing patients with guidance to help them get used to the referral system and discussing partial medical expenses, (3) increasing the payment criteria for critical care at hospitals and providing hospitals with guidance to help them reduce service provided to patients with mild conditions, (4) strengthening the collaboration between hospitals and clinics to realize continuous care, (5) improving people's knowledge and skills in taking care of themselves, and (6) enhancing management of medical foundations. All of the above measures have practically taken into consideration people's habits in seeking medical care and the convenience for healthcare facilities to provide diagnostic and treatment services.

  As far as strengthening the referral system, the NHIA plans to reduce primary care service provided by medical centers and regional hospitals on a yearly basis. According to the conclusions reached in the global budget discussion for 2017, primary care service provided by medical centers and regional hospitals may not exceed a certain ratio of the 2016 level; otherwise, the excess will not be included in the global budget.

  The NHIA indicates that they will ask medical centers and regional hospitals to reduce primary care service they provide on a yearly basis starting from next year; the goal is to enable medical centers to focus on teaching, research, and care for acute, severe, and critical conditions as they should. As part of the effort, NTD 6 billion will be invested next year to help increase the payment fee schedule for critical conditions so that hospitals can manage primarily critical conditions. As for how primary care or mild condition is defined, the NHIA will establish the criteria following sufficient discussions with the medical community in the near future.

  Statistics show that medical centers, regional hospitals, district hospitals, and clinics accounted for 31.8%, 27.0%, 16.6%, and 24.6%, respectively, of the overall medical expenses in 2006. If this trend continues, it is expected that the ratios will become 34.5%, 33.0%, 11.8%, and 20.7%, respectively, by 2020. In order to lessen the issue of "hardly one bed is available" in medical centers and to further empower clinics, strengthening the referral system is indeed a required measure.

  The NHIA indicates that existing chronic patients being treated at hospitals will not be forced to leave their current hospitals, since they have formed a sense of trust with their original doctors.

  Some people have said that the availability of clinics on holidays is not high. In order to address this issue, the NHIA is now discussing the possibilities of increasing the registration fee on holidays, adjusting the outpatient service load to be reasonable for Stage 1, and compiling information on availability of affiliated healthcare facilities throughout the nation; such information will be available by downloading the NHI mobile app or by searching on the NHIA website. A 24-hour telephone number for the community medical group will be provided so that people can get medical information to make medical care on holidays more convenient.

  The NHIA emphasizes that there are many packages that go with the measures of strengthening the referral system while it is being promoted. Feedback in all respects will be collected and discussed next year following the initial implementation to ensure a win-win-win situation for the people, the medical community, and National Health Insurance.

  • Date:2016-11-13