【Column Article】United Daily News Network – “Lee Po-Chang’s Column｜Will National Health Insurance Go Bankrupt If Seniors Are Exempted from Paying Premiums?”
The hottest topic recently is the exemption of seniors from paying National Health Insurance (NHI) premiums. However, the Legislative Yuan’s Kuomintang (KMT) party argued yesterday that this matter still requires further discussion, leading to a temporary halt on the proposal. Observing the situation’s development, officials’ narratives are riddled with political rhetoric, the medical community is fanning the flames, and the public remains confused about the actual financial issues of NHI. KMT Chairman Eric Chu stated that subsidies for seniors’ health insurance are already in place in 10 cities and counties, including Kinmen, Matsu, Penghu, Hsinchu City, and the six major metropolitan areas, covering over two-thirds of the nation’s population. The proposal aims to provide health insurance subsidies to seniors in poorer or disadvantaged counties. Importantly, the NHI global budget, which the medical community is most concerned about, remains unaffected. The “health insurance premiums exempted for seniors” will be paid to the NHI Administration by local governments, effectively reallocating social welfare budgets. This undoubtedly helps garner votes from families with senior citizens. To put it bluntly, local governments want to play the good guy, shifting their financial burdens onto the central government.
The issue isn’t about whether the NHI premium shortfall of NT$38.4 billion should be borne by the central or local governments. The core problem lies in the concept of “social welfare” tied to free medical services, which inevitably leads to runaway medical expenditures. This could collapse the medical point value system that the medical community holds dear. In Japan, also an aging society, seniors previously enjoyed exemption from partial out-of-pocket medical costs. However, they found that many seniors began treating hospital visits as leisure activities. Since 2022, Japan introduced partial co-payments for seniors’ medical services. I have long advocated for “user co-payment” to instill cost awareness in the public, ensuring that Taiwan’s NHI can genuinely showcase its value.
No organization can ignore the reality of financial management! The mainstream view in Taiwan’s medical community is that government health investment is relatively insufficient compared to OECD countries. However, the medical sector has avoided confronting unnecessary medical behaviors. Currently, 70% of resources are spent on outpatient services, leaving healthcare workers who treat acute and severe inpatient cases without adequate compensation. This imbalance has created the phenomenon of “sweatshop hospitals.” Only by pragmatically adjusting medical reimbursement standards can we resolve the distorted healthcare ecosystem.
Bankruptcy typically refers to the inability of an individual, company, or other entity to pay off its debts. Under the current NHI law, its finances are self-sustaining. Taiwan’s global budget operates under an “expenditure ceiling,” meaning there’s always a cap on annual budget growth. However, there is no upper limit on points for medical services, tests, and medications. Controlling these points involves the practical management of the entire NHI system. The current proposal is for hospitals to manage their budgets independently. How would hospitals regulate doctors’ practices when patients keep seeking treatment? Providing patients with quality and necessary care is our responsibility as medical professionals. Poorly managed NHI might lead to disruptions and inefficiencies in care delivery.
President Lai Ching-te’s proposed “Healthy Taiwan” blueprint aims to reduce the nation’s unhealthy life expectancy. Practically, this involves enhancing chronic disease care, such as diabetes, hypertension, arthritis, and cancer. Family physicians are expected to take on a crucial gatekeeping role in this reform.
For years, Taiwan’s NHI has oscillated between being a system of social welfare and social insurance, remaining a topic of debate among scholars and the medical community. I would like to remind the “Healthy Taiwan Committee” that it lacks representatives from the field of public health. Only through transparent dialogue between the medical and public health sectors can Taiwan’s NHI continue to progress.
In my view, pragmatic health policies are the government’s responsibility, while high-quality medical services depend on the healthcare workforce. Citizens receiving medical care must also shoulder their share of responsibility. At this point, implementing a tiered healthcare system is the key reform for Taiwan’s medical system. Integrating “user co-payment” as part of the plan will be essential to truly transform the NHI into a more robust and sustainable system.
Original Source: United Daily News Network – “Will National Health Insurance Go Bankrupt If Seniors Are Exempted from Paying Premiums?”
