Bureau of National Health Insurance

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National Health InsuranceNational Health Insurancein Taiwanin Taiwan

Bureau of National Health Insurance2007

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AgendaAgenda

Country Profile Overview of the NHI Current Status

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Country ProfileCountry Profile

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TaiwanTaiwan

Where is Taiwan?Where is Taiwan?

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Map of TaiwanMap of Taiwan

Taiwan's most prominent

physiographic feature is

its 270-kilometer central

mountain range, which

boasts more than 200

peaks with an elevation

over 3,000 meters.

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Profile of TaiwanProfile of Taiwan(2005)(2005)

Population: 22.7 million Land area: 36,190km2 (14,000 mile²) Population density: 629 per km2

Population aged over 65 : 9.7% GDP per capita : US $15,291 NHE as % of GDP: 6.16%

Sources: Ministry of Interior,Directorate-General of Budget Accounting and

Statistics,Department of Health

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Health Indices (2005)Health Indices (2005)

Crude Birth Rate: 9.1 0/00

Crude Death Rate: 6.10/00

Infant Mortality Rate: 5.0 0/00

Natural Increase Rate: 2.9 0/00

Maternal Mortality Rate: 7.3 0/0000

Life Expectancy: 73.7 Male

79.8 Female

Sources: Ministry of Interior,Department of Health

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Public/Private Mix of Providers Public/Private Mix of Providers (2006)(2006)

Public Private Total

Hospitals 79 (15%)

463 (85%)

542 (100%)

Clinics 427 (2%)

17,311 (98%)

17,738 (100%)

Beds 33,875 (30%)

78,098 (70%)

111,973 (100%)

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Closed-staff system for hospitals Dominated by the private sector No gate-keeper system for outpatient

visits Patients are free to choose care

providers High service volumes in outpatient

department in most hospitals

Features of the Features of the Healthcare SystemHealthcare System

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Overview of the NHI ProgramOverview of the NHI Program

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1950 Labor Insurance1958 Government Employees’ Insurance1985 Farmer’s Insurance 1990 Low-income Household Insurance1995 National Health Insurance

*Health insurance coverage rate before 1995 was 59%

Milestones in Social InsuranceMilestones in Social Insurance

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Eastern Region Eastern Region BranchBranch

Taipei Branch

NHI HeadquarterNorthern Region Branch

Central Region Branch

Southern Region Branch

Kao-Ping Branch

Organization ChartOrganization Chart

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The Insured The Insured

BNHIBNHI

Premiums NHI Cards

Copayment

Medical Services

Payments Medical Claims

Flow of Healthcare System Flow of Healthcare System under the NHIunder the NHI

Providers Providers

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Characteristics of NHI (1)Characteristics of NHI (1)

Mandatory enrollment Single-payer payment system Operated by government agency Payroll-related premium rate Contribution shared by the employer,

the employee and the government

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Comprehensive benefit package Fee-for-service and case payment

under the global budget payment scheme

Co-payment for outpatient care, inpatient care, and drugs

Characteristics of NHI (2)Characteristics of NHI (2)

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Enrollment EligibilityEnrollment Eligibility

All Citizens

Foreigners with resident permits

Dependents of the aforementioned

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Inpatient care Outpatient care Laboratory tests Prescription drugs and certain OTC

drugs Dental services Traditional Chinese medicine Day care for the mentally ill Home care

Benefit CoverageBenefit Coverage

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Inpatient care Outpatient care Laboratory tests Prescription drugs and certain OTC

drugs Dental services Traditional Chinese medicine Day care for the mentally ill Home care

Benefit CoverageBenefit Coverage

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Premium Contribution SharesPremium Contribution Shares(current premium rate: 4.55%)(current premium rate: 4.55%) Unit:%

Category Government Employer Employee

1st Private-sector Employees 10 60 30

Government Employees __ 70 30

Self-employed / Employers __ __ 100

2nd Union members 40 __ 60

3rd Farmers / Fishermen 70 __ 30

4th Conscripted military personnel

100 __ __

5th Low-income households 100 __ __

6th Veterans 100 __ __

Community groups 40 __ 60

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Calculation of Insurance PremiumCalculation of Insurance Premium

Calculation formula:

insurable income ×premium rate × share of contribution ×(1+number of dependents)

For example: Mr. Chen is a private sector employee with a monthly income of NT$30,300 (USD 866) and he has two dependents

He needs to pay: $30,300×4.55%×30%×(1+2)=$1,241 (USD35) per month

(1 USD = 35 NTD)

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Copayment for Outpatient CareCopayment for Outpatient Care Unit:USD

(1 USD = 35 NTD)

Outpatient Care

Emergency Care

Dental Care & Chinese Med.

Drug (20%)

Academic Medical Centers

Through Referral

Without Referral

6 10

13

1. 5

0~6

Regional Hospitals Through Referral Without Referral

4 7

9 1. 5 0~6

District Hospitals/Clinics

Through Referral Without Referral

1.5 2

4. 5

1. 5

0~6

Copayment exemption: catastrophic diseases, child delivery, medical services offered at mountain areas or offshore islands, low-income households, veterans, children under the age of 3

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Length of Stay Coinsurance Rate

within 30 days 10%

31 to 60 days 20%

Above 61 days 30%

Coinsurance for Inpatient CareCoinsurance for Inpatient Care(Acute Care)(Acute Care)

Coinsurance ceiling: US$686 per stay and US$1,143 cumulative for the entire calendar year (for the same disease that causes the patient to stay no more than 30 days in the acute ward or 180 days in the chronic ward).

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Exemptions of CopaymentExemptions of Copayment

Low-income households Catastrophic diseases Child delivery Medical services offered at the defined

mountain areas or on offshore islands Veterans Children under the age of 3

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Relief Measures for the Disadvantaged GroupRelief Measures for the Disadvantaged Group

100% premium subsidy for low-income households

Partial premium subsidy for the disabled, elderly and the jobless

Premium Relief for the near poor: payment by installment, donations from charity organization, interest-free loans

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Development of Payment SystemDevelopment of Payment System

1995 - Fee for Service

1997 - Case Payment, currently 53 items

1998 - Global Budget Payment Scheme

2001 - Quality Based Payment Scheme

2004 - Resource-Based Relative Value Scale

System (RBRVS)

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Current StatusCurrent Status

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Major Achievements of NHIMajor Achievements of NHI

Universal coverage Easy access Affordable costHigh public satisfactionAcceptable Quality

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99%

1%

Insured Uninsured

Population Covered ： 22 .3 million (99%)

Universal Enrollment Universal Enrollment

• Staying abroad• Homeless people are hard to locate

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Easy AccessEasy Access

In 2006,there were 18,289 healthcare providers contracted with BNHI, representing 91.45% of all providers

Since1996, implemented an integrated delivery system (IDS Plan ) to improve services in remote mountainous areas and offshore islands.

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25%

37%

38%

Total revenues in 2006: NT$367billion (US$10.5 billion)

Premium RevenuesPremium Revenues

EmployerEmployer

GovernmentGovernmentInsuredInsured

US$3.9Billion

US$4.0 BillionUS$4.0 BillionUS$2.6 BillionUS$2.6 Billion

(1 USD = 35 NTD)

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35%65%

Total Spending in 2006 : NT$ 423billion payment points (US$12.1 billion)

Medical ExpendituresMedical Expenditures

Outpatient Care

Inpatient Care

US$4.2 Billion

US$7.9 Billion

(1 USD = 35 NTD)

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382.1

361.0352.2

336.8

307.6286.1

285.2

264.9

194.0

241.3 243.6260.5

382.2367.4

352.6337.1

323.3301.8

284.2

285.9

156.8

222.9 237.6

262.0

0

40

80

120

160

200

240

280

320

360

400

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Insurance Revenues

Insurance Cost

Insurance Cost Average growth rate : 5.54%

Insurance Revenues Average growth rate :4.70%

Trend of NHI Financial StatusTrend of NHI Financial StatusUnit: NT$bn

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NHI IC CardNHI IC Card

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Content of IC CardContent of IC Card

NHI IC card

IC Chip Explicit Data

Basic Data SectionHealthcare Data SectionMedical Data SectionHealth Administration Data Section

NameBirth dateID NumberPhotograph (Optional)

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High SatisfactionHigh Satisfaction (1995 ～ 2007.6)

Satisfied (DOH)Satisfied (BNHI)

Dissatisfied (DOH)Dissatisfied (BNHI)

77.50%

64.30%

63.40%71.70%

72.30%

76.60%78.60%77.60%76.30%70.90%

78.50%

71.1%

65.6%63.3% 63.8%

67.2%66.5%

61.0%

50.2%

39.0%

65.4% 68.3% 59.70%

13.30%

36.5%

22.5%

23.4% 22.10%27.80%

34.10%

36.10%

22.10%

11.60%17.00%

29.60%20.1%25.9%

24.2%

24.5%

22.0%

27.0%

47.0%

20.60% 15.90%17.2%

13.60%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Satisf ied Dissatisf ied

05/95 09/95 06/96 01/98 04/98 11/98 05/99 03/00 10/00 06/01 12/01 05/02 11/02 07/03 12/03 04/04 09/04 12/04 06/05 12/05 06/06 12/06 06/07

Premium & Copayment Adjusted

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Http://www.nhi.gov.tw

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Thank you Thank you for your kind attention!for your kind attention!