Transcript 費率及部分負擔調整說明

Bureau of National Health Insurance
National Health Insurance
in Taiwan
Bureau of National Health Insurance
2007
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Bureau of National Health Insurance
Agenda
 Country Profile
 Overview of the NHI
 Current Status
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Bureau of National Health Insurance
Country Profile
3
Bureau of National Health Insurance
Where is Taiwan?
Taiwan
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Bureau of National Health Insurance
Map of Taiwan
Taiwan's most prominent
physiographic feature is
its 270-kilometer central
mountain range, which
boasts more than 200
peaks with an elevation
over 3,000 meters.
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Bureau of National Health Insurance
Profile of Taiwan
(2005)
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Population: 22.7 million
Land area: 36,190km2 (14,000 mile²)
Population density: 629 per km2
Population aged over 65 : 9.7%
GDP per capita : US $15,291
NHE as % of GDP: 6.16%
Sources: Ministry of Interior,Directorate-General of Budget Accounting and
Statistics,Department of Health
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Bureau of National Health Insurance
Health Indices (2005)
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Crude Birth Rate: 9.1 0/00
Crude Death Rate: 6.10/00
Infant Mortality Rate: 5.0 0/00
Natural Increase Rate: 2.9 0/00
Maternal Mortality Rate: 7.3 0/0000
Life Expectancy: 73.7 Male
79.8 Female
Sources: Ministry of Interior,Department of Health
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Bureau of National Health Insurance
Public/Private Mix of Providers
(2006)
Hospitals
Clinics
Beds
Public
Private
Total
79
463
542
(15%)
(85%)
(100%)
427
17,311
17,738
(2%)
(98%)
(100%)
33,875
78,098
111,973
(30%)
(70%)
(100%)
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Bureau of National Health Insurance
Features of the
Healthcare System
 Closed-staff system for hospitals
 Dominated by the private sector
 No gate-keeper system for outpatient
visits
 Patients are free to choose care
providers
 High service volumes in outpatient
department in most hospitals
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Bureau of National Health Insurance
Overview of the NHI Program
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Bureau of National Health Insurance
Milestones in Social Insurance
1950
1958
1985
1990
1995
Labor Insurance
Government Employees’ Insurance
Farmer’s Insurance
Low-income Household Insurance
National Health Insurance
*Health insurance coverage rate before 1995 was 59%
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Bureau of National Health Insurance
Organization Chart
Northern Region
Branch
Central Region
Branch
Southern Region
Branch
NHI Headquarter
Taipei Branch
Eastern Region
Branch
Kao-Ping Branch
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Bureau of National Health Insurance
Flow of Healthcare System
under the NHI
Copayment
Providers
The Insured
Medical Services
Premiums
NHI Cards
Payments
Medical Claims
BNHI
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Bureau of National Health Insurance
Characteristics of NHI (1)
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Mandatory enrollment
Single-payer payment system
Operated by government agency
Payroll-related premium rate
Contribution shared by the employer,
the employee and the government
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Bureau of National Health Insurance
Characteristics of NHI (2)
 Comprehensive benefit package
 Fee-for-service and case payment
under the global budget payment
scheme
 Co-payment for outpatient care,
inpatient care, and drugs
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Bureau of National Health Insurance
Enrollment Eligibility
 All Citizens
 Foreigners with resident permits
 Dependents of the aforementioned
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Bureau of National Health Insurance
Benefit Coverage
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Inpatient care
Outpatient care
Laboratory tests
Prescription drugs and certain OTC
drugs
Dental services
Traditional Chinese medicine
Day care for the mentally ill
Home care
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Bureau of National Health Insurance
Benefit Coverage
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Inpatient care
Outpatient care
Laboratory tests
Prescription drugs and certain OTC
drugs
Dental services
Traditional Chinese medicine
Day care for the mentally ill
Home care
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Bureau of National Health Insurance
Premium Contribution Shares
(current premium rate: 4.55%)
Category
Unit:%
Government
Employer
Employee
Private-sector Employees
10
60
30
Government Employees
__
70
30
Self-employed / Employers
__
__
100
2nd
Union members
40
__
60
3rd
Farmers / Fishermen
70
__
30
4th
Conscripted military
personnel
100
__
__
5th
Low -income households
100
__
__
6th
Veterans
100
__
__
40
__
60
1st
Communit y groups
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Bureau of National Health Insurance
Calculation of Insurance Premium
Calculation formula:
insurable income ×premium rate × share of
contribution ×(1+number of dependents)
For example: Mr. Chen is a private sector employee
with a monthly income of NT$30,300 (USD 866) and
he has two dependents
He needs to pay: $30,300×4.55%×30%×(1+2)=$1,241
(USD35) per month
(1 USD = 35 NTD)
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Bureau of National Health Insurance
Copayment for Outpatient Care
Unit:USD
Outpatient
Care
Academic
Centers
Medical
Through Referral
Without Referral
Regional Hospitals
Through Referral
Without Referral
District
Hospitals/Clinics
Through Referral
Without Referral
Emergency
Care
Dental Care &
Chinese Med.
Drug
(20%)
13
1. 5
0~6
9
1. 5
0~6
4. 5
1. 5
0~6
6
10
4
7
1.5
2
Copayment exemption: catastrophic diseases, child delivery, medical services offered at mountain areas or
offshore islands, low-income households, veterans, children under the age of 3
(1 USD = 35 NTD)
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Bureau of National Health Insurance
Coinsurance for Inpatient Care
(Acute Care)
Length of Stay
Coinsurance Rate
within 30 days
10%
31 to 60 days
20%
Above 61 days
30%
Coinsurance ceiling: US$686 per stay and US$1,143 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).
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Bureau of National Health Insurance
Exemptions of Copayment
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Low-income households
Catastrophic diseases
Child delivery
Medical services offered at the defined
mountain areas or on offshore islands
 Veterans
 Children under the age of 3
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Bureau of National Health Insurance
Relief Measures for the Disadvantaged Group
 100% premium subsidy for low-income
households
 Partial premium subsidy for the
disabled, elderly and the jobless
 Premium Relief for the near poor:
payment by installment, donations from
charity organization, interest-free loans
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Bureau of National Health Insurance
Development of Payment System
1995 1997 1998 2001 2004 -
Fee for Service
Case Payment, currently 53 items
Global Budget Payment Scheme
Quality Based Payment Scheme
Resource-Based Relative Value Scale
System (RBRVS)
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Bureau of National Health Insurance
Current Status
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Bureau of National Health Insurance
Major Achievements of NHI
 Universal coverage
 Easy access
 Affordable cost
 High public satisfaction
 Acceptable Quality
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Bureau of National Health Insurance
Universal Enrollment
Population Covered：22 .3 million (99%)
1%
• Staying abroad
• Homeless people are
hard to locate
99%
Insured
Uninsured
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Bureau of National Health Insurance
Easy Access
 In 2006,there were 18,289 healthcare
providers contracted with BNHI,
representing 91.45% of all providers
 Since1996, implemented an integrated
delivery system (IDS Plan ) to improve
services in remote mountainous areas
and offshore islands.
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Bureau of National Health Insurance
Premium Revenues
Total revenues in 2006: NT$367billion (US$10.5 billion)
Employer
US$3.9Billion
37%
Insured
US$4.0 Billion
38%
25%
Government
US$2.6 Billion
(1 USD = 35 NTD)
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Bureau of National Health Insurance
Medical Expenditures
Total Spending in 2006 : NT$ 423billion payment points
(US$12.1 billion)
Inpatient Care
US$4.2 Billion
35%
65%
Outpatient Care
US$7.9 Billion
(1 USD = 35 NTD)
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Bureau of National Health Insurance
Trend of NHI Financial Status
Unit: NT$bn
Insurance Cost Average growth rate : 5.54%
400
352.6
360
323.3
320
285.9
280
241.3
243.6
260.5
160
194.0
222.9
285.2
301.8
262.0
240
200
367.4
264.9
284.2
286.1
382.1
337.1
352.2
382.2
361.0
336.8
307.6
237.6
Insurance Revenues Average growth rate :
4.70%
156.8
120
80
Insurance Revenues
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Insurance Cost
0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
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Bureau of National Health Insurance
NHI IC Card
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Bureau of National Health Insurance
Content of IC Card
NHI IC card
IC Chip
Basic Data Section
Healthcare Data Section
Medical Data Section
Health Administration Data Section
Explicit Data
Name
Birth date
ID Number
Photograph (Optional)
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Bureau of National Health Insurance
High Satisfaction
(1995～2007.6)
90.0%
78.50%
80.0%
70.0%
65.4%
60.0%
50.0% 47.0% 50.2%
40.0%
30.0% 39.0%
20.0%
66.5%
71.1%
68.3%
70.90%
59.70%
67.2%
76.60%
Satisfied (DOH)
(BNHI)
PremiumSatisfied
& Copayment
36.5%
22.5%
23.4%
25.9%
24.2%
22.0%
10.0%
Satisfied
Dissatisfied
63.40%
17.2%
13.60%
29.60%
20.60%
15.90%
64.30%
36.10%
27.80%
22.10%
34.10%
24.5%
20.1%
71.70%
Dissatisfied (DOH)
Dissatisfied (BNHI)
Adjusted
27.0%
77.50%
72.30%
65.6%
63.8%
63.3%
61.0%
78.60%
76.30%
77.60%
13.30%
22.10%
17.00%
11.60%
0.0%
05/95 09/95 06/96 01/98 04/98 11/98
05/99 03/00 10/00 06/01 12/01 05/02 11/02 07/03 12/03
0 4/04 09/04 12/04 06/05 12/05 06/06 12/06 06/07
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Bureau of National Health Insurance
Http://www.nhi.gov.tw
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Bureau of National Health Insurance
Thank you
for your kind attention!
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