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Amendment to National Health Insurance Referral Guidelines: Co-Payment benefits for 4 Re-Visits Within 1 Month after Referral

  To implement bilateral referrals, the Ministry of Health and Welfare (MOHW) announced today (April 13) the amendments made to the National Health Insurance Referral Guidelines, stipulating that referral patients making four re-visits within one month after being referred shall be deemed as being referred and shall be eligible for co-payment benefit. This amendment is aimed at encouraging citizens with injuries or illnesses to first seek medical attention from primary care. This measure will be implemented on April 15 simultaneously with the new system of co-payments for emergency visits.

  The MOHW began implementing the adjustments of co-payments for emergency visits since its announcement on April 15, 2017. Co-payments for referrals to medical centers and regional hospitals will be adjusted from NT$210 and NT$140 to NT$170 and NT$100, respectively. Co-payments for non-referrals to medical centers will be adjusted from NT$360 to NT$420. Co-payments for emergency triage levels 3 to 5 in medical centers will be adjusted from NT$450 to NT$550; levels 1 and 2 remain unchanged.

  The National Health Insurance Administration (NHIA) states that to prevent patients from seeking medical consultation at medical centers regardless of the severity of their illnesses, cooperation in the form of division of labor among medical institutions of varying levels will be implemented to provide patients with the most adequate care. The NHIA introduced 6 strategies and 24 measure packages, which involve introducing a family physician system and building a referral platform that is accessible and easy to use.

  To implement bilateral referral, the NHIA amended provisions of the National Health Insurance Referral Guidelines according to opinions collected from patient support groups and medical experts. Relevant legal procedures have been completed and will be implemented on April 15 this year. The key aspects of the amended referral guidelines are as follows:

(I).Implementing bilateral referrals: After the insured is being referred for treatment, and his/her medical condition no longer requires treatment at the hospital/clinic accepting the referral, the insured should be advised to return to the hospital/clinic where he/she was treated originally or to other suitable hospital/clinics to receive follow-up treatment.

(II).Keeping priority consultations for referred patients: Contract facilities should set up appropriate facilities and personnel to provide adequate medical arrangements for referred beneficiaries, and keep a certain number of priority openings for referred patients.

(III).Specifying the valid period of the referral form: Contract facilities should issue referral forms to insured persons requiring referral. The valid period of the referral form should be 90 days at most, beginning from the date at which the form is issued.

(IV).Relaxing the definition of referral scope: For patients seeking medical attention with their referral forms, who are deemed by their physicians as requiring continued inpatient treatment, if they do not exceed four re-visits within one month after being referred, they shall be deemed as being referred.

(V).Recommending adopting the e-referral system: Regarding the details that should be clearly listed on the referral form, contract facilities are advised to send referral forms by using NHIA's e-referral platform.

  NHIA states that the e-referral platform has been implemented for use since March 1, 2017. As of April 12, 1,264 hospitals/clinics have used the e-referral platform to complete referrals and share information. 372 community medical groups were among those that participated in the Family Physician Integrated Care Project. This platform has helped over 3,700 patients complete referrals. It is expected that all family physician medical groups will complete bilateral referrals through this platform by June this year.

  The NHIA recommends insureds to choose their neighboring physicians as their own family physicians. The NHIA is actively increasing the service capacity of the Family Physician Integrated Care Project. In 2017, 526 community medical groups (approx. 4,000 primary care clinics) and 184 hospitals will be collaborating to provide members of the public with better real-time referral services, including: Prioritized registration and fees waivers, efficient channels (examinations, inpatient treatment, surgery and hospitalization), bilateral medical information sharing, and a 24-hour service hotline. In addition, referral physicians also participate in shared-care outpatient and hospital ward round services of the collaborating hospital to understand the treatment conditions of referred patients.

  Through sharing of medical information and value-added services provided by different collaborating hospitals, patients can return to the primary care where they was treated originally to have continuous care.

  • Date:2017-04-13