National Health Insurance Administration Ministy of Health and Welfare

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Headline: BNHI to Launch "Capitation Pilot Project" Starting July 1, 2011 to Help Public Receive More Comprehensively Integrated Care

  Under the current NHI payment system, although part of hospitalization claims paid under the diagnosis-related group (DRG) payment method, most medical services are still paid on a fee-for-service basis. As a result, medical care providers tend to provide more services for more payment. There is a lack of incentive for medical care providers to improve the insured's health. In view of this, the BNHI has realized that in order to encourage medical institutions to enhance preventive health care such as providing health education on correct diet/living style for patients so as to decrease medical expenditures and to improve public health, it is necessary to promote the capitation payment system to deliver greater benefits to the public, medical care providers, and the insurer.

  This project has openly recruited pilot teams since February 23, 2011, and as of March 31, a total of 25 medical institutions/teams nationwide have applied. After review by scholars and experts invited by the BNHI, 8 medical institutions (or teams) have been chosen as official pilot hospitals or teams, including: Kinmen Hospital, Department of Health, Executive Yuan, Cheng Ching Hospital and 11 local clinics, Chang Bing Show Chwan Memorial Hospital and 42 local health centers or clinics, National Taiwan University Hospital Jinshan Branch Hospital and 2 local health centers or clinics, Zhih Shan Clinic and 5 collaborative clinics, Cordinal Tien Hospital, Changhua Christian Hospital, and Pingtung Christian Hospital. More than 300,000 people could be included in this pilot project. This pilot project will start from July 1, 2011 and will run for 3 years.

  This project uses 3 pilot models. The first is the regional integration model which targets all registered population in the involved administrative region, with the integrated service provided by medical institutions/teams. The second is the community medical group model: the community medical group involved in the "Family Physician Integrated Care Project" will take charge of this model, and service will also include hospitalization. The third is the hospital-loyal patient model: the target population will be the loyal patients participating in the "Project of Establishing Integrated Care Model with Gradual Progress towards Facilitating Medical System Integration", and service will include hospitalization as well. Considering the convenience to seek medical care, during the implantation of pilot project, the insured is free to choose any medical institution for treatment. For your reference, the BNHI has posted information regarding the pilot models and service content of the eight pilot teams (as in the annex) on its website on May 13.

  To enable smooth progress of this pilot project, the BNHI will invite scholars and experts to make on-site visits to the eight medical institutions (or teams) and provide consultation after 6 months of implementation of the project, and will organize an observation conference after 1 year of implementation to facilitate information exchange and learning between pilot teams. In addition, the BNHI will regularly review the outcome of this pilot project to provide the best integrated care service to the public, with "Health for All" as the ultimate goal.

  • Date:2011-06-03