taiwan’s national health insurance: the experience and reform of a single-payer system 1 yi-ren...
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Taiwan’s National Health Insurance: The Experience and Reform of
a Single-payer System
11
Yi-Ren Wang, MS, MLDirector, Planning DivisionBureau of National Health Insurance31st, October, 2011
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Yi-Ren Wang
No relationships to disclose
22
Characteristics of the NHI in Taiwan
CoverageCompulsory enrollment for all citizens and legal residents
Administration Single-payer system run by the government
FinancingPayroll-based premium shared by the employee, employer and government
Benefits Comprehensive package, copayment required
Providers 92% of providers contracted with NHI
Payment Uniformed fee schedule under the global budget
PrivilegesPremium and copayment subsidies for the disadvantaged
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Major Achievements of NHI
Universal coverage
Equitableprotection
Affordable cost
High public satisfaction
Improved health status
44
Population Covered : 23 .1 million (99.51%)
Universal Coverage
• Mainly people staying abroad
55
Government 34.8%
Enterprise 27.7%
Households 37.5%
I (Lowest
Income)3.0%
II 5.9%
III 7.7%
IV 9.1%
V (Highest
Income)11.8%
I (Lowest Income)
13.7%
II 17.9%
III 20.9%
IV 23.1%
V (Highest Income)
24.5%
Premium ContributionNT$ 4550 Billion
Benefit Received*NT$ 4615 Billion
Benefit / PremiumRatio
4.9 times
3.3 times
2.9 times
2.7 times
2.2 times
66
Average: 2.9 times
Premium Revenues & Benefits Received by Different Income Groups (1996~2009)
Equitable Protection
*There is a deficit of NT$ 65 Billion (1.4%)
Affordable CostAverage Annual Growth Rate of Medical Expenses (1999-2008)
77
Source : OECD Health Data 2010, Department of HealthNote : Japan (1998-2007) , Australia (1998-2007)
Improved Health Status
10 Years Prior to NHI
Standard mortality rate has decreased by 12%
Standard mortality rate has decreased by 12%
Average life expectancy at birth increased 1.0/1.9 (male/female) years
Average life expectancy at birth increased 1.0/1.9 (male/female) years
10 Years After NHI
Standard mortality rate has decreased by 18%
Standard mortality rate has decreased by 18%
Average life expectancy at birth increased 1.9/2.1 (male/female) years
Average life expectancy at birth increased 1.9/2.1 (male/female) years
88
Source: Department of Health, Taiwan
99
High Public Satisfaction(1995~2010)
Deficit observedagain
194.0
241.3 243.6260.5
264.9
285.2
286.1307.6
336.8352.2 361.1
381.9 387.4402.0 403.1
461.2
156.8
222.9237.6
262.0
285.9
284.2
301.8 323.3337.1
352.6367.4 382.2
401.2 415.9434.8
443.2
100
140
180
220
260
300
340
380
420
460
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Premium Revenues
Medical Expendiures
Annual growth rate from 1996 to 2010Medical Expenditure : 5.03
Premium Revenue : 4.73
year
NT$ billion
1010
Challenges1/2
NHI Financial Status
1.Adjust copayment2.Increase other revenue3.Strict review
1.Adjust premium rate2.Adjust copayment 3.Implement Global Budget system
1.Adjust copayment2.Increase other revenue
Adjust premium rate
The Rates of Salary to Total Taxable Income
1111
Challenges2/2
Low High
Income Groups
%
Source: Government Finance Annual Report for 2011, Ministry of Finance, Taiwan
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The 2nd Generation of NHI
July 2001
September 2004
May 2006
January 2011
Text 2 Text 3The 2nd Generation NHI Planning Task Force was formed under the Executive Yuan.
The Department of Health started to draft the NHI Act amendment.
The NHI Act amendment proposal was submitted to the Congress for review.
The NHI Act amendment was passed by the Congress and promulgated by the President.
Financing ReformFinancing Reform
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Annual bonuses
Stock dividends
Income from professional
practice
Saving interests
Income from part-time or sideline jobs
Rentals
× 2%
Imposing Supplementary Premium to the Insured
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Monthly payroll × 4.91%( ? ) × 30% × (1+ 0~3 dependents)
Employees’ contribution share
Estimated new premium rate
Basic premium
Suppl. premium
Benefit Reform
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Decision Making Process for Benefits Coverage
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Health Technology AssessmentHealth Technology Assessment
4
Health issues
Financial impact on the
insurance
Medical ethics
Cost effectiveness
Public ConsensusPublic Consensus
Representatives of medical providers
+Insurer
+Representatives of payers,
scholars and related agencies
Payment Reform
1717
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Developing Diversified Payment Schemes
RBRVS (1st 2004, 2nd 2011)
1995 1998~2002 2010 20112001
• 7 diseases•Address new P4P projects to achieve a 5% annual growth rate of the enrollees.
• Phasing in Tw-DRGs up to 60% of the inpatient care.
• Initiate 3-year pilot project for 3 different capitation models.
Final Words
Adding non-payroll incomes into the premium base is a breakthrough for Taiwan’s social insurance.
Enlarged payment unit is expected to integrate medical services with preventive medicine to facilitate our ultimate goal of buying “health” rather than “healthcare”.
Reform for NHI is endless.
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