2012 National Health Insurance in Taiwan. Bureau of National Health Insurance Department of Health Taiwan

Transcription

1 2012 National Health Insurance in Taiwan Bureau of National Health Insurance Department of Health Taiwan 1

2 Facts about Taiwan (2010) Land Area 36,191 km 2 Population 23 millions Density 641/km 2 Population aged over % Per Capita GDP US$18,588 NHE in GDP 6.6% Life Expectancy M: 76.2 / F:

3 Health Care Resources ( 2010) Sector Public Private Total Hospitals 82 (16.1%) 426 (83.9%) 508 (100%) Clinics 461 (2.3%) 19,722 (97.7%) 20,183 (100%) Beds 46,580 (29.3%) 110,160 (70.7%) 158,922 (100%) Source: DoH Statistics 3

4 Social Insurance in Taiwan 1950 Labor Insurance (40.1%) 1958 Government Employees Insurance (8.5%) 1985 Farmers Insurance (8.2%) 1990 Low income Household Insurance (0.6%) 1995 National Health Insurance (99%) *( ) indicates % of total population. 4

5 Characteristics of NHI Coverage Administration Financing Benefits Providers Payment Privileges Compulsory enrollment for all citizens and legal residents Single payer system run by the government Payroll based premium Government and employers share contribution for the insured and their dependents Uniformed package, copayment required 92% of providers contracted with NHI Uniformed fee schedule under the global budget Premium and copayment subsidies for the disadvantaged 5

6 NHI Structure Tobacco tax Other Lottery revenues Premium Payment NHI IC Claims Card Copay Employer Medical Services Government 6

7 NHI Financial Status NT$ billion NHI expenditures have grown at an average of 5.03% a year ( ) NHI revenues have grown at an average of 4.73% a year ( ) year 14

8 Premium Contribution Rate Premium rate: 5.17% of monthly payroll Category Government Employer Insured Unit:% 1st Private sector Employees 10 (0.517%) 60 (3.102%) 30 (1.551%) Government Employees Self employed / Employers 100 2nd Union members of independent workers rd Farmers / Fishermen th Conscripted Military personnel 100 (5.17%) 5th Low income households 100 (5.17%) 6th Veterans 100 (5.17%) Community groups

9 Copayment for Outpatient Care Unit:USD$ Academic Medical Centers Outpatient Care* Emergency Care Dental Care/ Chinese Med. Drug (20%) ~6 Regional Hospitals ~6 District Hospitals/ Clinics ~6 * Copayment is partially waived for visits referred by primary physicians. Exemptions: 1. Catastrophic diseases, child delivery 2. Medical services offered at mountain areas or offshore islands 3. Low income households, veterans, children under the age of 3 (1 USD = 33 NTD) 9

10 Copayment for Inpatient Care (Acute Care) Length of Stay Copayment Rate within 30 days 10% 31 to 60 days 20% above 61 days 30% Coinsurance ceiling: US$900 per stay and US$1,500 cumulative for the entire calendar year (for the same disease that causes the patient to stay no more than 30 days in the acute ward or 180 days in the chronic ward). (1 USD = 33 NTD) 10

11 Benefit Coverage Inpatient care Outpatient care X ray exam, laboratory tests Prescription drugs and certain OTC drugs: 1,208 Chemical entities, brand items. Dental services Traditional Chinese medicine Preventive care: well baby, prenatal, pap. smear, mammography, etc.

12 Reimbursement Schemes FFS + Case Payment Global Budget RBRVS DRGs 4 sectoral budgets: 1998 Dental care 2000 Traditional Chinese Medicine 2001 Clinics 2002 Hospitals 12

13 Access to Medical Care Patients are free to choose from 24,423 providers for medical services. No waiting list as defined in western countries. Integrated delivery system (IDS) was implemented to improve services in remote mountainous areas and offshore islands. 13

14 IC-Chipped Health Insurance Card Notes: Registration of important tests and drug prescriptions as well as records of medical visits, catastrophic disease registration, organ donation or palliative care registration. Usage monitoring: High usage cases are managed via file analysis. 14

15 Utilization Status No. of Outpatient Visit per Person Hospitalization per 100 Persons 15

16 Assistances for the Disadvantaged Statutory premium subsidies Low income household Handicapped The elderly The temporarily unemployed Financial assistances for the near poor NHI Relief Fund Loans Payment by installments Charity donation referrals Medical assistances for the disadvantaged Guaranteed emergency services Copayment subsidies and exemption 16

17 Alleviates Financial Burdens of Disadvantaged Patients with catastrophic diseases represent 3.56% of population, who used 27.13% of NHI medical expenditures. Year: 2010 Type of Users Medical Expenses Equivalency Average NT$22,799 1 Acute cerebrovascular disease NT$89, Per cancer patient NT$136,578 6 Per dialysis patient NT$601, Per patient on respirator NT$714, Per hemophilia patient NT$2,729,

18 Up to standard Quality Five-year Survival Rates for Cancer Unit: % Colon Cancer Lung Cancer Breast Cancer male female male female female Taiwan ( ) United States ( ) Australia ( ) Organ Transplant Survival Rate Taiwan No. of Cases ( ) 3-month Survival Rate Taiwan ( ) 1 Year Survival Rate 3-year Survival Rate US ( ) Taiwan US ( ) Taiwan US ( ) (1997- (1997- deceased living 2007) deceased living 2007) deceased living Kidney graft % 98% 99% 96% 95% 98% 94% 89% 95% Liver graft % 94% 95% 84% 87% 90% 81% 79% 85% Heart graft % 93% 80% 88% 73% Lung graft 79 61% 92% 49% 84% 32% 80% 68% 18

19 High Public Satisfaction Rate % (1995~2010) Premium & Copayment Adjusted (I) 2002 (II) Satisfied Dissatisfied 19

20 Major Achievements of NHI Universal coverage Easy access Affordable cost High public satisfaction Up to standard quality 20

21 Recent Reforms of Taiwan s NHI 1. Imposing supplementary premium in addition to payroll related premium on the insured and the employers. 2. Increasing the government's financial contribution responsibility 3. Extending coverage to prisoners 4. Enhancing measures to contain excessive use of healthcare resources 21

22 Supplementary Premium Basic premium Monthly payroll premium rate 30% (1+ 0~3 dependents) employee contribution share Supplementary premium annual bonuses stock dividends income from professional practice interest from savings income from part-time or sideline jobs rental income 2% 22

23 Coverage Decision for New Drugs Almost all prescription drugs are covered. Drug review committee makes three decision: A. Listing in drug formulary B. Pricing C. Restriction in drug indication, if necessary

24 Criteria for Coverage Decision Safety: Taiwan s FDA Efficacy: Taiwan s FDA Relative effectiveness Budget impact analysis CBA/CEA/PE Ethical/Legal/Social/Political Impact

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26 Thank you for your kind attention! 26