National Health Insurance in Taiwan

1. National Health Insurancein Taiwan Bureau of National Health Insurance 2007

2. Agenda • Country Profile • Overview of the NHI • Current Status

3. Country Profile

4. Where is Taiwan? Taiwan

5. Map 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.

6. Profile of Taiwan (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

7. 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

8. Public/Private Mix of Providers (2006)

9. Features of the Healthcare System • 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

10. Overview of the NHI Program

11. Milestones in Social Insurance 1950 Labor Insurance 1958 Government Employees’ Insurance 1985 Farmer’s Insurance 1990 Low-income Household Insurance 1995 National Health Insurance *Health insurance coverage rate before 1995 was 59%

12. Organization Chart NHI Headquarter Northern Region Branch Taipei Branch Central Region Branch Eastern Region Branch Southern Region Branch Kao-Ping Branch

13. Flow of Healthcare System under the NHI Copayment Providers The Insured Medical Services NHI Cards Payments Premiums Medical Claims BNHI

14. 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

15. Characteristics of NHI (2) • Comprehensive benefit package • Fee-for-service and case payment under the global budget payment scheme • Co-payment for outpatient care, inpatient care, and drugs

16. Enrollment Eligibility • All Citizens • Foreigners with resident permits • Dependents of the aforementioned

17. Benefit Coverage • 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

18. Benefit Coverage • 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

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

20. Calculation 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)

21. Copayment for Outpatient Care Unit:USD 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 (1 USD = 35 NTD)

22. Coinsurance for Inpatient 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).

23. Exemptions 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

24. Relief 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

25. Development 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)

26. Current Status

27. Major Achievements of NHI • Universal coverage • Easy access • Affordable cost • High public satisfaction • Acceptable Quality

28. Universal Enrollment Population Covered：22 .3 million (99%) • Staying abroad • Homeless people are • hard to locate

29. Easy 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.

30. Premium Revenues Total revenues in 2006: NT$367billion (US$10.5 billion) Employer US$3.9Billion Government Insured US$2.6 Billion US$4.0 Billion (1 USD = 35 NTD)

31. Medical Expenditures Total Spending in 2006 : NT$ 423billion payment points (US$12.1 billion) Inpatient Care US$4.2 Billion Outpatient Care US$7.9 Billion (1 USD = 35 NTD)

32. Trend of NHI Financial Status Unit: NT$bn

33. NHI IC Card

34. Content of IC Card NHI IC card Explicit Data IC Chip Basic Data Section Healthcare Data Section Medical Data Section Health Administration Data Section Name Birth date ID Number Photograph (Optional)

35. High Satisfaction (1995～2007.6) Satisfied (DOH) Satisfied (BNHI) Dissatisfied (DOH) Dissatisfied (BNHI) Premium & Copayment Adjusted 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

36. Http://www.nhi.gov.tw

37. Thank you for your kind attention!