Cross-Generation Dialogue: Discussing NHI Reformation between Various Generations

2021-12-03

With the effects of the COVID-19 pandemic, the sustainability of Taiwan’s National Health Insurance (NHI) has drawn considerable attention. After holding the Ultimate Limit of National Health Insurance symposium, National Yang-Ming University (NYMU) convened a seminar entitled “National Health Insurance Reform During the Pandemic: A Cross-Generational Dialogue” on October 9th. Scholars, experts, medical professionals, and consumers representing various generations were invited to participate in a cross-generation dialogue to provide a range of opinions and explore possible directions for NHI reform.

The seminar was co-organized by the Taiwan Society of Health Economics (TaiSHE), the Taiwan Economics Association, and NYMU’s Research Center for Epidemic Prevention (RCEP) and covered four themes: copayment and waste control, copayment balancing and private insurance, reasonable increases in medical expenses and adjustments to health insurance premiums, and cross-generational dialogue regarding NHI reform. Unlike in the previous seminar, which was centered around experts in the field of public health, the nearly 200 participants in this seminar were mostly young and middle-aged representatives of organizations from Taiwan Medical Alliance for Labor Justice and Patient Safety, the Taipei Doctors Union, and the Taiwan Nursing and Medical Industries Union as well as representatives from medical institutions and doctors unions to voice a range of opinions from frontline medical professionals.

NYMU President Steve Kuo indicated that NHI will be reformed not only in terms of the system itself but also in terms of intergenerational justice and that NHI remaining as is would be unfair to the young generation. This is also related equity, which must be addressed through the NHI reform. Numerous teachers and alumni of NYMU are closely associated with NHI. The objective of the reform is to create a platform for rational communication.

Shu-Ling Tsai, the deputy director of the National Health Insurance Administration, indicated that with the aging population and declining birthrates, the old-age-dependency ratio has become a key concern; from the perspective of financial stability, 2021 is the right moment for the NHI reform because according to statistics on NHI income and expenditure and current NHI premiums, safety reserves will only suffice for 0.33 months in 2022; this period is shorter than the 1–3 months stipulated by the parent act, and negative number of months is expected for 2023. Although the parent act remains to be amended, an immediately feasible measure would be to adjust premiums and the scope of payment and consider the current economy and overall burden to the public. In addition, a series of amendments are required to expand the premium rate and ensure fairness.

Chou Ying-Jenq, Chairman of the TaiSHE and a professor in NYMU’s Institute of Public Health, indicated that in terms of the percentage of gross domestic product (GDP) represented by health care expenditures, Taiwan ranks fifth lowest among Organisation for Economic Co-operation and Development member countries; in terms of mean life expectancy, Taiwan ranks last compared with its neighbors South Korea, Singapore, and Japan. Although the establishment of NHI in 1995 reduced premiums, the subsequent economic growth and population aging caused medical expenditures to increase. Therefore, premiums must be increased to improve the quality of medical care.

Allen Lien, deputy CEO of the RCEP (Deputy Director of Business Development at Medigen Vaccine Biologics Corporation) who just graduated from Harvard University, stated that Taiwan’s satisfaction with NHI is nearly 90%, which complicates the reform. In addition, the system is based on cultural values such as respect for seniors and aiding the poor and sick. Therefore, the system does not impose as many restrictions on payment for senior patients and major injuries as do other countries, which increases the percentage of expenditure represented by such payment. As Lien describes, “issues of cultural value often require consistent and progressive communication.”

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