![\"\"](\"https:\/\/tmuhprc.tmu.edu.tw\/wp-content\/uploads\/2025\/10\/1761721123764.jpg\")
<\/p>\n<\/p>\n
2025-10-28<\/p>\n
Taiwan\u2019s 30-year-old National Health Insurance (NHI) system is now facing a \u201cmidlife crisis.\u201d With worsening financial strain, an exodus of medical professionals, and life-saving medicine turning into a \u201cmoney-losing business,\u201d the core problem is not that there isn\u2019t enough money\u2014but that the system has been miscalculating its accounts<\/em>.<\/p>\n Former NHI Director-General Lee Po-Chang<\/strong> pointed out that the fundamental illness of Taiwan\u2019s health insurance lies in misallocated resources and structural flaws<\/em>, summarized in three key imbalances: misplaced expenditures<\/strong>, mispriced reimbursements<\/strong>, and imbalanced responsibilities<\/strong>. Once hailed as the \u201cpride of Taiwan,\u201d the NHI\u2019s sustainability has been gradually eroded.<\/p>\n Although next year\u2019s NHI budget will surpass NT$1 trillion<\/strong>, Taiwan\u2019s medical system remains in distress. Human resources in internal medicine, surgery, obstetrics and gynecology, and critical care are collapsing; the wave of resignations continues to expand with no end in sight. The NHI\u2019s pressure is rapidly spreading to the medical frontlines. What exactly is happening on the ground?<\/p>\n According to Lee, the NHI\u2019s total expenditure exceeds NT$800 billion annually, but the spending structure is severely imbalanced\u201470%<\/strong> goes to outpatient services, while only 30%<\/strong> supports inpatient and critical care that require intensive manpower and technology.<\/p>\n This imbalance is closely tied to the current fee-for-service<\/strong> payment system. To maintain revenue through point-based reimbursement, hospitals increase the number of consultations, prescriptions, and diagnostic tests\u2014because \u201cthe more you do, the more you can claim.\u201d As a result, vast resources are poured into revenue-generating but non-life-saving procedures like CT and MRI scans, while genuine life-saving interventions have become financial losses.<\/p>\n Lee cited international data suggesting that a balanced ratio should be 45% outpatient to 55% inpatient<\/strong>, showing how distorted Taiwan\u2019s resource allocation has become. He emphasized the need to adjust reimbursement standards to shift resources back toward inpatient and critical care\u2014only then can the issue of \u201csweatshop hospitals\u201d begin to improve.<\/p>\n Lee explained that the NHI system has long undervalued the labor of healthcare professionals. The reimbursement points for specialized services were set too low and have not been adjusted for inflation or labor costs, leaving medical workers underpaid despite long hours and high pressure.<\/p>\n \u201cThe massive outflow of healthcare workers is no coincidence,\u201d he said. Current payment standards devalue the efforts of medical staff\u2014especially surgeons, critical care specialists, and nurses\u2014causing chronic workforce shortages that ultimately compromise patient safety and quality of care.<\/p>\n He described it as a structure where \u201cthe more lives you save, the more you lose.\u201d High-risk and critical care procedures are reimbursed far below actual cost, making \u201csaving lives\u201d a money-losing endeavor.<\/p>\n Lee urged reforms to increase reimbursement points<\/strong> for surgical, critical care, and inpatient services, ensuring fair compensation for medical expertise. Only when resources flow back to truly life-saving care can the system regain a healthy balance. \u201cOtherwise,\u201d he warned, \u201cno matter how much money we add, it will just be misplaced again\u2014and the problems will remain.\u201d<\/p>\n Reflecting on his tenure leading NHI reform, Lee admitted that the \u201cuser-pays\u201d co-payment policy<\/strong> was never fully implemented due to political constraints\u2014a missed reform opportunity. He said the government has long treated the NHI as a \u201cpolitical virtue project,\u201d making people careless in their use of medical resources.<\/p>\n He emphasized that citizens must be made to bear personal responsibility<\/em> through co-payment mechanisms. Only when patients pay part of the cost \u201cout of pocket\u201d will they develop real awareness of medical expenses. \u201cCo-payment is essential,\u201d Lee said. \u201cIf we rely only on moral persuasion, it will never work.\u201d<\/p>\n He warned that if politicians continue to let people believe \u201cseeing a doctor is free,\u201d the inevitable outcome will be the exploitation of healthcare workers\u2014\u201cand one day, it will explode.\u201d Only by encouraging citizens to share costs and recognize their responsibility can the NHI system remain sustainable.<\/p>\n Behind this long-term systemic imbalance, Lee also highlighted two often-overlooked dangers: radiation overexposure from excessive testing<\/strong> and medical waste from the reckless construction of local hospitals<\/strong>.<\/p>\n NHI resources have long been concentrated in easily reimbursable testing procedures such as CT and MRI scans. This not only wastes funding but also exposes patients to unnecessary radiation risks.<\/p>\n Lee noted that Taiwan\u2019s medical community \u201cuses far too much radiation.\u201d People often undergo repeated scans without realizing the long-term DNA damage such exposure can cause.<\/p>\n Citing studies, he said that frontline radiologic technologists have a significantly higher cancer rate than the general population\u2014proof that radiation hazards may take 10\u201320 years to appear. This kind of defensive medicine<\/strong> exposes patients to invisible risks and represents another cost of the NHI\u2019s systemic imbalance.<\/p>\n Physicians, seeking to avoid malpractice disputes, tend to \u201cdo more rather than less,\u201d while patients\u2014detached from cost awareness\u2014request more tests because they\u2019re covered by insurance. The result: double waste of radiation and resources.<\/p>\n Lee recommended adopting international practices: if a test is deemed unnecessary after professional assessment and yields a negative result, the patient should pay out of pocket<\/strong> to uphold the \u201cuser-pays\u201d principle and curb excessive testing.<\/p>\n Lee criticized local governments\u2019 recent trend of blindly building hospitals<\/strong> as a form of regional development or real-estate promotion, which runs counter to medical reform goals and causes severe dilution of resources.<\/p>\n He explained that a hospital requires a steady income stream and patient volume to operate, but NHI budgets have not increased proportionally, and manpower remains scarce. When new hospitals are built without demand, they struggle to survive and are forced to \u201ctreat one patient as three\u201d by encouraging repeated visits to sustain revenue.<\/p>\n This, he said, squanders vast medical resources and is unsustainable. Hospital construction decisions should be made by those who truly understand healthcare systems\u2014not for political gain. Otherwise, new hospitals will engage in unhealthy competition just to survive, dragging the entire medical system into a vicious cycle.<\/p>\n Lee concluded that the true problem of the NHI lies not in insufficient funding but in the miscalculation of resource allocation and institutional design<\/strong>. From spending imbalance and undervalued labor to the lack of user accountability, these misalignments have driven Taiwan\u2019s healthcare system toward chronic overwork, inequity, and inefficiency.<\/p>\n He stressed that for NHI sustainability, reforms must return to core principles:<\/p>\n Redirect resources to truly life-saving care,<\/p>\n<\/li>\n Reward professional medical value fairly, and<\/p>\n<\/li>\n Rebuild citizens\u2019 sense of responsibility in healthcare use.<\/p>\n<\/li>\n<\/ul>\n Only then can the NHI evolve from quantitative expansion to qualitative sustainability<\/strong>, returning to its founding mission\u2014\u201csharing risk and safeguarding health.\u201d<\/strong><\/p>\n <\/p>\n Original source\uff1ahttps:\/\/www.gvm.com.tw\/article\/125403<\/p>\n","protected":false},"excerpt":{"rendered":" 2025-10-28 Taiwan\u2019s 30-year-old National Health Insurance (NHI) system is now facing a \u201cmidlife crisis.\u201d With worsening financial strain, an exodus of medical professionals, and life-saving medicine turning into a \u201cmoney-losing business,\u201d the core problem is not that there isn\u2019t enough money\u2014but that the system has been miscalculating its accounts. Former NHI Director-General Lee Po-Chang pointed […]<\/p>\n","protected":false},"author":14,"featured_media":6783,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[91],"tags":[],"yoast_head":"\n
\nFirst Miscalculation \u2014 Misplaced Expenditures: 70% for Outpatient, 30% for Inpatient Care<\/strong><\/h3>\n
\nSecond Miscalculation \u2014 Mispriced Reimbursements: Undervalued Medical Labor<\/strong><\/h3>\n
\nThird Miscalculation \u2014 Systemic Imbalance: Responsibility Gap Between the Public and the Medical Sector<\/strong><\/h3>\n
\nHidden Danger 1 \u2014 Overtesting: Radiation Overuse and Health Risks<\/strong><\/h3>\n
\nHidden Danger 2 \u2014 Hospital Construction Mania: Resource Dilution and Medical Waste<\/strong><\/h3>\n
\nToward Sustainable Health Insurance: Restoring Balance in Resources, Value, and Responsibility<\/strong><\/h3>\n
\n