Taipei: President Lai Ching-te on Saturday called for structural reforms to the National Health Insurance (NHI) system, including the adoption of a "different pay for different work" model, to address an ongoing shortage of physicians in Taiwan. "Does the NHI have problems right now? Yes, it does. One issue is the sustainability of its finances, with the other being the difficulty in recruiting medical professionals," Lai said at an event marking the 30th anniversary of the NHI's introduction in Taiwan. "It's not just nurses we're having trouble recruiting -- the same goes for doctors," Lai added.
According to Focus Taiwan, Lai suggested that the current fee-for-service model, in which doctors are paid based on the number of services performed, should be reviewed. He proposed that a "different pay for different work" model be adopted as part of structural reforms to the NHI system. Lai highlighted that if doctors are performing different kinds of work but receiving the same pay, fewer doctors might choose more demanding specialties, such as internal medicine, surgery, obstetrics and gynecology, and pediatrics. However, it was not exactly clear what new structure Lai was proposing, as he did not provide any details.
Currently, the National Health Insurance Administration (NHIA) sets a schedule annually for what it reimburses for different services. To address imbalances, there is a mechanism for revising payments if certain services are deemed underpaid. NHIA Director-general Shih Chung-liang mentioned that the reimbursement system could be adjusted. The agency is considering dividing outpatient consultations into two types-general and complex-that would earn different reimbursement rates for doctors.
Shih noted that given the variance in time and complexity of surgical procedures across specialties, some departments already receive different levels of payment based on a resource-based relative value scale (RBRVS), a system used to determine appropriate compensation for medical providers. Nevertheless, Shih admitted that payments for services in certain specialties might not have been fully adjusted and said they will be reviewed gradually in the near future.
Additionally, Shih announced that starting May 1, the drug vosoritide will be covered by the NHI for young patients with achondroplasia, a rare genetic disorder affecting bone growth. Despite its annual cost of around NT$7 million (US$210,839) per person, the drug allows patients to live normal lives and contribute to society. Shih stated that 72 young patients with achondroplasia across Taiwan will benefit from the new NHI coverage.