| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 95 === The purpose of this study was to understand and compare the Health Insurance Systems between Taiwan and Korea. The discussion focused on issues of the insurers, the insured, financial policy, benefits packages, and payment systems. The study method was literature review, and further analyze using data provided by OECD, Taiwan, and Korea governments. Important results are as follows:
1.The insured
In Taiwan, the insurance rate was 99%; in Korea, health insurance is divided into two parts: 1. health insurance population (96.29%), 2. low-income population (3.71%, 2006). The insured are divided into six categories in Taiwan, but into only the employee insured and the self-employed insured in Korea. Citizens who are unable to pay the premium and the overdue charge pay through installments for individual overdue payment, NHI Relief Funds Loan, or Referral Services in Taiwan, and through Disposition on Loss in Korea.
2.Financial policies
The financial resources for Taiwan and Korea are both premiums. The premium rate in Taiwan is 4.55%, and 4.77% for the working insured in Korea. Premium adjustment was made once in Taiwan (2002), but adjusts each year in Korea. In Taiwan, 38% of the total premium income is from the insured, 36% from the group insurance applicants, and 26% from government subsidies. In Korea, subsidies are 40% for the self-employed insured’s health insurance coverage and operation and management expenses for their health insurance business. Both countries are facing financial crisis. In order to solve the deficit problem, Korean government uses health surcharge on tobacco, adjustment of premium rate, and health insurance payment claims. In Taiwan, global budgeting is used to control increase of medical expenses. Also, adjusting the ceiling of enrollment cost, public officials and servicemen’s enrollment rate, amount of health surcharge on tobacco, and expanding the payment difference between basic outpatient service and outpatient service in each class of hospitals were applied.
3. Benefits packages
Average number of outpatient visits per person each year is about 14 times in Taiwan and 14.13 times in Korea. In Taiwan, different co-payment methods are applied to all classes of hospitals based on with or without referral and the inpatient days. No co-payment is applied in catastrophic illness and childbirth. In Korea, inpatient and chronic dialysis patients pay 20% of the total amount. No co-payment is applied on natural childbirth and inpatient children under six. Cancer patients and patients with catastrophic illness pay 10% of the medical costs. The problem of destitution due to sickness still exists in Korea. The catastrophic illness systems in Taiwan protects citizens from destitution due to sickness. About 26% of the total medical expenses are on patients with catastrophic illness. Since September, 2005, Korean applied the “Cancer patient registration system”, and results in a large number of decrease in co-payments.
4.Payment Systems
The payment methods of both countries are based on fee for service. In Taiwan, after global budgeting payment system comes into effect, the growth rate of medical expenses each year is under 5%. Also, medical service quality indicator was established through the quality ensuring policy. There are 53 items of case payment currently used in Taiwan. TW-DRGs will be carried out from January, 2008. After the failure of DRGs in Korea, medical service institutions chose different methods to use since year of 2001.
5.Suggestions
To Korea: Lead in the health insurance IC card or Personal Identification card, subsidies programs for low-income households, programs for patients with catastrophic illness, more programs on government’s subsidies and taxation, and take into consideration of the effects decade-later before carrying out a new policy.
To Taiwan: Use health education and advertising programs to improve the behavior of “hospital shopping”, adjusting premium rate, and disseminate and educate preventive health care.
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