Taiwan docs, consumers bicker over national health insurance budget

TAIPEI - Doctors and consumer groups traded verbal blows yesterday as the National Health Insurance (NHI) programme started calculating the budget for next year's payments.

The association representing the nation's doctors accused the Consumer Foundation (CF) of spreading misinformation about the use of the NHI budgets, which it said should see a major increase next year to prevent the medical institution from collapsing.

Many doctors have left Taiwan because of a growing, yet undeserved, hostility against them in the nation and much better working environments in places abroad such as mainland China, said the Taiwan Medical Association (TMA).

But the CF said that last year the NHI had given hospitals the funding they needed to expand their in-patient accommodation facilities, but instead they reduced their capacity.

The CF called on the government to check whether the NHI funding has been used properly.

Every year, the NHI sets a fixed lump sum for payments to all medical institutions under the insurance programme. The lump sum will increase annually, but the growth has to be agreed by representatives from consumer and medical groups, as well as government officials.

Hospitals have been accounting for the lion's share of NHI's budget, which is expected to grow 1.58 to 4.45 per cent to at least NT$560 billion next year.

Hospitals are expected to take about NT$360 billion (S$ 15 billion) of the total, with about NT$121 billion going to regional clinics, NT$38 billion to dentists and NT$33 billion to dialysis treatments.

Teng His-hua, a spokesperson for a group monitoring the NHI, said the programme's budget has been burgeoning since its introduction in 1995 when the total sum was only NT$160 billion.

The fast increase has been the result of inflation, aging of the population and advances in medical technology, Teng said.

But as salary levels have been stagnant, it means patients are less capable of paying for their medical expenses, the spokesperson said, urging the government increase its medical spending.

At the same time, Teng said, the NHI must exert tighter control on its trial programs, which need NT$30 billion to run each year. The amount is almost equivalent to the budget for dialysis patients, Teng said.

Some observers said the tight control on NHI budget growth will worsen the lack of personnel for the medical institution. Two of the most affected medical groups are gynecologists and obstetricians.

The observers added that the tight budget will make expensive imported drugs unaffordable and drive away international pharmaceutical firms. Doctors will have to rely on locally produced generic drugs, they said.

The NHI will neither cover expensive treatments using advanced technology, and patients will have to pay for themselves, the observers said.

The TMA said Taiwan's medical spending has been low. It amounted to only 6.6 per cent of GDP in 2011, lower than the United States (17.7 per cent), Canada, France and Germany (11 per cent each), Japan (9.6 per cent) and South Korea (7 per cent).

The TMA said more than 400 doctors - many of them being gynecologists and obstetricians - have left Taiwan, and another 1,000 have often been traveling to mainland China for "short-term" practices.

The exodus of doctors from Taiwan will worsen if the NHI funding and the poor working environment do not improve, it said.

The TMA said gynecologists and obstetricians are among the groups of doctors who have been facing frequent lawsuits over alleged malpractices.

Medical students are reluctant to become gynecologists or obstetricians, and many rural areas in Taiwan have none of them, the TMA said.