【Media Interview】United Daily News User Co-payments in National Health Insurance Are Not Meant to Punish the Public — They Are Intended to Create Space for Better Quality Care
User Co-payments in National Health Insurance Are Not Meant to Punish the Public — They Are Intended to Create Space for Better Quality Care
May 17, 2026, 12:29 PM | United Daily News – Vitality Weekly
Excerpted from Unnecessary Medical Care That Gets Paid For: The Invisible Drain on Healthcare
Hospital operations in Taiwan rely heavily on resources provided through National Health Insurance (NHI). Naturally, hospitals can only submit claims when patients come in for treatment. Therefore, when I served as superintendent of Tainan Hospital, I also encouraged physicians to arrange blood tests and X-rays whenever possible in order to secure NHI reimbursement.
However, after joining the National Health Insurance Administration (NHIA), I came to believe that this type of medical practice needed to change. Once, during a lecture, a nurse colleague from Tainan Hospital asked me:
“Director-General, when you were a hospital superintendent, you didn’t think this way.”
I responded that this was a classic example of “changing positions changes perspectives.” After all, the NHIA’s responsibility is to properly manage the nation’s healthcare resources as a whole.
Making Test Results Shareable Through the Cloud
My professional background is in surgery. Before performing surgery, a physician must establish a clear diagnosis—you cannot simply start cutting and decide what to do along the way.
After entering public service, I realized that every policy decision requires sufficient sensitivity to identify the true nature of the problem. My awareness of unnecessary medical care emerged partly from practical observation. Most local clinics only have basic equipment such as stethoscopes and blood pressure monitors, while many laboratory tests and imaging examinations are conducted at major hospitals. As a result, patients became accustomed to returning to large hospitals for follow-up care.
Under the concept of hierarchical medical care, we hoped patients could instead return to nearby family physicians for ongoing follow-up. Therefore, we sought to integrate imaging reports, CT scans, and other medical information into a cloud-based healthcare information-sharing system so that clinic physicians could access these reports directly from their computers.
Honestly speaking, the establishment of this system by NHIA staff was a milestone in healthcare reform. It also enabled us to better understand real-world data for policy reform purposes. I personally regard this as one of the most important achievements during my service in the NHIA.
Repeated High-End Imaging Tests Waste Resources and Increase Medical Burdens
With improvements in the information system, we discovered that a very high proportion of repeated CT and MRI examinations within a one-month period were medically unnecessary. These redundant tests not only waste healthcare resources but also increase the workload of healthcare personnel.
In 2017, among diagnostic testing expenditures under NHI:
- CT scans ranked first with 10.381 billion reimbursement points,
- Ultrasound ranked second with 8.605 billion points,
- MRI ranked third with 6.225 billion points.
Through big data analysis, the NHIA found a troubling pattern: many patients underwent CT or MRI examinations but never returned to review the results with the original hospital physician. Some even went to another hospital to undergo the same examination again.
For CT scans alone, in 2017:
- 127,000 outpatient CT examinations (excluding emergency visits) involved patients who did not return to the original hospital within 30 days, accounting for 14% of all CT cases and costing 560 million reimbursement points.
- An additional 42,000 cases involved patients seeking care at other hospitals without returning for their original CT report, accounting for another 5% and costing 180 million points.
Combined, this means that 19% of CT patients did not require immediate follow-up treatment after the examination. Yet these examinations still consumed 740 million NHI reimbursement points.
Even more concerning, 7% of these patients did not return for any medical visit within 90 days, representing another 280 million reimbursement points.
Receiving Tests Without Reviewing Results: The Invisible Loss of Healthcare Resources
When patients undergo expensive examinations but never return to review the results, it essentially means either:
- they never fully understood their medical condition, or
- they repeated the same tests elsewhere without reviewing prior findings.
We believe some patients assume they are “probably fine” if symptoms improve, while others mistakenly believe hospitals will proactively notify them of abnormal findings. Both assumptions are problematic and may contribute to unnecessary waste.
Similar issues exist with many other examinations:
- X-rays
- blood tests
- urine tests
and more.
Repeated testing and failure to return for result explanations are common.
Physicians should help safeguard the system by ensuring patients return for follow-up discussions and by providing appropriate health education. Reducing healthcare waste may help ease pressure for future NHI premium increases—ultimately benefiting the entire population.
Reducing Unnecessary Care Creates Space for Better Quality
Since April 2017, the NHIA has implemented a shared results system for major examinations and tests. Participating medical institutions are encouraged to upload reports promptly for system-wide access.
When patients visit contracted healthcare providers and insert their NHI cards for verification, physicians now receive automatic reminders on their computer screens showing:
- examinations performed within the past six months, and
- the most recent examination dates.
This system helps reduce duplicate testing, which not only wastes healthcare resources but may also expose patients to unnecessary physical risks.
Reducing unnecessary medical care is actually a prerequisite for improving healthcare quality.
One frequently overlooked fact is that unnecessary care itself harms the quality of care available to those who truly need it. When healthcare resources are consumed by large volumes of low-value services:
- healthcare manpower becomes diluted,
- waiting times increase,
- high-risk and high-need patients are crowded out.
Reducing unnecessary care is therefore not about sacrificing quality—it is about creating space for quality.
Co-payments Are a Governance Tool, Not a Punishment
Within this context, user co-payments and partial cost-sharing should not be viewed merely as tools for reducing NHI expenditures.
They are governance tools designed to improve healthcare quality.
Co-payments are not intended to punish the public. Rather, they are tools for correcting distorted price signals. When healthcare utilization becomes almost costless to patients, it becomes difficult for demand-side users to distinguish between necessary and unnecessary care. Overutilization then becomes an inevitable outcome.
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