A study on the financial balance mechanism of National Health Insurance in Taiwan

• Main Authors: Chin-Yi Lee, 李進益
• Other Authors: JIU YANG JIAN
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/32672461388168155380

碩士 === 中原大學 === 會計研究所 === 94 === The National Health Insurance was established formally in March of 1995 to provide a mandatory social health insurance system specializing in payment of medical treatment. The National Health Insurance launched with two great political missions: Promote the universal coverage of social health insurance (in accordance with the declaration, ' Health for All ', of World Health Organization) and reform the social insurance finance. As of today the NHI coverage rate has reached 99% already, and the universal mission of ' Health for All' has been achieved at present. However, because of the current serious financial deficit that NHI is facing, the second political mission, ' financial reform of the social insurance ' is still an urgent problem to be solved on public policy, and it is still the important financial problem that policymakers and executors must face cautiously. Therefore, the research purpose of this text is to systematically investigate and study the financial responsibility of NHI system currently in effect, to analyze why the NHI financial condition was mired in difficulties, and to find out the factors which affect the NHI financial balance and its main regulation mechanism relevantly. Then we' all propose more feasible financial reform tactics that let every stakeholders while having the benefit of NHI, bear relative financial responsibility too. Basically, the factors that influence NHI financial balance can roughly be divided into two categories, natural factor and human factor. According to the study and analysis of this research, we can categorize the human and natural factors into three constructs, the financial revenue and expenditure, medical supply and demand, and NHI system, to sum up good reform tactics. This article summarizes the scholars' and experts' opinions and practical experience and concludes that the NHI has faced the following predicaments at present, which have influenced the financial situation of NHI directly or indirectly: First, the financial status is seriously out-of-balance. Second, the insurance premium is unfairly distributed. Third, NHI revenue and expenditure are not reasonably correlated. Fourth, the resource distribution lacks of good mechanism; Fifth, the medical information is not transparent enough. Sixth, the Payment standard policy is unreasonable. In the face of the above-mentioned financial challenge of NHI, we must make a self-criticism of the expenditure and revenue. In addition, supply and demand in medical market and innovation of NHI system are decisive factors to the success of NHI financial reform. In this article, we proposed the following reform tactics pertinent to the above-mentioned three constructs, the financial revenue and expenditure, medical supply and demand, and NHI system: (1) In respect of financial revenue and expenditure: Adjust the insurance premium and payment scheme to expand the flexibility of insurance premium base, and enhance the function of deductible policy and system, Strive for the people's acceptance and recognition, press for the NHI subsidy arrears of governments at all levels, set up the NHI Poverty-relief Fund, reorganize the financial outfit to cope with different economic cycles, strictly control and reduce waste of medical resources, strengthen the function of global budget system . (2) In respect of medical supply and demand: establish and comply with all the regulations related to medical practitioners and suppliers, promote the fair participation of all people in demand of medical treatments. (3) In respect of NHI system: We propose the optional schemes of NHI system according to future NHI positioning policy, for instance: Set up the national health insurance committee and reform the system to be independent groups of government bodies; Under Department of Health there can be an unitary Bureau of National Health Insurance; Set up Division of NHI and Bureau of National Health Insurance inside the Department of Health; Set up a corporatization NHI foundation under Department of Health; Under Department of Health, there can be a Bureau of National Health Insurance and six NHI coperations;or set up a single corporatization NHI foundation under Department of Health and make multiple-purpose insurances open to public access in the meantime. Whether the NHI can be ever lasting definitely depends on whether we carry on financial reform. This article is to propose the above reform tactics for reference of the NHI planners and policymakers so as to achieve the long term financial healthiness and stability of NHI system.