【Exclusive Interview】If Patients Seek Medications and Tests Only for Peace of Mind, Health Insurance Will Collapse! How to Visit the Doctor Wisely in a Super-Aged Society?

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Interview by Mei-Chen Wang and Li-Chien Yen | Text by Li-Chien Yen | Photography by Ying-Ching Lee, Walk Daily | Venue Courtesy: Presta Coffee | Editor-in-Chief: Mei-Chen Wang

Editor’s Note:
Taiwan’s National Health Insurance (NHI) has provided comprehensive healthcare for over 30 years. However, as Taiwan’s population ages rapidly, the financial sustainability of NHI is under threat. As 2025 marks Taiwan’s entry into a super-aged society, Professor Lee Po-Chang from Taipei Medical University’s School of Public Health and former Director-General of the National Health Insurance Administration shares his insights in an exclusive interview with 50+. Below is a summary of the key points from the interview.

The Core of Taiwan’s Healthcare: National Health Insurance

Before the introduction of NHI, many people in Taiwan struggled to access proper medical care. However, new challenges have emerged since its implementation. The current crisis lies in the inability of the system to provide healthcare workers with a fulfilling work environment.

I began training as a surgeon in 1979. Back then, my brother Lee Po-Huang and Professor Lee Chun-Jen were performing kidney transplants at Taoyuan General Hospital, where I started working after graduation. Due to the limited efficacy of anti-rejection drugs at the time, many patients faced complications such as acute rejection or infections after surgery, requiring intensive care. Witnessing patients recover and start anew brought immense satisfaction.

Urgent Need: Happy Healthcare Workers Benefit Patients

The NHI was established to safeguard the health of all Taiwanese citizens. However, quality service can only be delivered when healthcare workers are content. Unfortunately, current NHI resources are strained, leading to widespread dissatisfaction among medical professionals.

While increasing funding could alleviate some issues, mismanagement and waste must first be addressed. Relying solely on raising premiums to generate revenue is not a sustainable solution and poses significant political risks. Prioritizing cost-saving measures and efficient resource allocation is more pragmatic.

Key Concepts: Global Budget, Fixed Points, and Floating Points

Taiwan’s NHI operates under a global budget system, with a total expenditure cap of approximately NT$870 billion for 2024. This budget is allocated among hospitals, primary care clinics, traditional Chinese medicine, and dental services, covering expenses such as medications, medical materials, diagnostic tests, and professional consultation fees.

The global budget system sets an annual spending limit. If the public’s usage of healthcare services exceeds projections, the “value per point” reimbursed to providers decreases. For instance, if hospitals are reimbursed at 90%, 1 point is worth NT$0.9 instead of NT$1, and so on. This is the concept of floating points. However, medication costs are reimbursed at a fixed value of NT$1 per point, which can strain resources if there is excessive or unnecessary prescription of drugs.

Two Major Areas of NHI Waste: Medications and Diagnostic Tests

Two significant sources of NHI waste are unnecessary medications and diagnostic tests. Currently, medication costs account for over 32% of the total NHI budget, up from the previous estimate of 25%. While new and expensive treatments, such as cancer drugs, are unavoidable, reducing wasteful prescribing practices is essential.

For example, some patients collect medications without taking them, merely seeking “peace of mind.” Similarly, 5% of patients issued diagnostic test orders annually do not undergo the tests, often because their symptoms resolve before they take action. Such inefficiencies divert funds away from necessary care and burden healthcare workers.

Implementing a Tiered Medical System: Choosing Clinics vs. Hospitals

Despite years of discussion, Taiwan’s tiered medical system remains challenging to implement. Patients often seek care at large hospitals for minor ailments, leading to resource overuse. From a hospital’s perspective, more tests equate to higher reimbursements, and some doctors practice “defensive medicine” to protect themselves from potential lawsuits.

To alleviate overcrowding, the goal was to reduce outpatient visits to medical centers and regional hospitals by 2% annually. However, this has proven difficult due to high patient demand.

In Hong Kong, for example, if a patient insists on an unnecessary CT scan, they bear the cost unless an issue is detected. Such measures encourage responsible use of healthcare services.

Patients should visit medical centers for acute, severe, or rare conditions, while clinics are more suitable for managing chronic illnesses or minor symptoms. Effective referral systems can ensure faster access to hospital care when necessary.

Adjusting Reimbursement Standards for Severe Cases

Reimbursement standards must also be adjusted. Healthcare providers caring for critically ill patients should receive higher compensation. Currently, outpatient services account for 70% of NHI spending, while inpatient care—which often requires intensive resources—accounts for only 30%.

By revisiting allocation priorities and ensuring fair compensation for time-intensive specialties, such as neurology, Taiwan can better support its healthcare workforce and sustain the NHI system.

原文出處：FIFTY PLUS《民眾若拿藥、檢查只為心安，健保會垮！超高齡社會下，你該怎麼正確看醫生？臺北醫學大學公衛學院教授、前健保署長李伯璋專訪》