Bureau of National Health Insurance
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National Health InsuranceNational Health Insurancein Taiwanin Taiwan
Bureau of National Health Insurance2007
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AgendaAgenda
Country Profile Overview of the NHI Current Status
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Country ProfileCountry Profile
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TaiwanTaiwan
Where is Taiwan?Where is Taiwan?
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Map of TaiwanMap 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.
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Profile of TaiwanProfile of Taiwan(2005)(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
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Health Indices (2005)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
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Public/Private Mix of Providers Public/Private Mix of Providers (2006)(2006)
Public Private Total
Hospitals 79 (15%)
463 (85%)
542 (100%)
Clinics 427 (2%)
17,311 (98%)
17,738 (100%)
Beds 33,875 (30%)
78,098 (70%)
111,973 (100%)
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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
Features of the Features of the Healthcare SystemHealthcare System
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Overview of the NHI ProgramOverview of the NHI Program
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1950 Labor Insurance1958 Government Employees’ Insurance1985 Farmer’s Insurance 1990 Low-income Household Insurance1995 National Health Insurance
*Health insurance coverage rate before 1995 was 59%
Milestones in Social InsuranceMilestones in Social Insurance
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Eastern Region Eastern Region BranchBranch
Taipei Branch
NHI HeadquarterNorthern Region Branch
Central Region Branch
Southern Region Branch
Kao-Ping Branch
Organization ChartOrganization Chart
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The Insured The Insured
BNHIBNHI
Premiums NHI Cards
Copayment
Medical Services
Payments Medical Claims
Flow of Healthcare System Flow of Healthcare System under the NHIunder the NHI
Providers Providers
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Characteristics of NHI (1)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
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Comprehensive benefit package Fee-for-service and case payment
under the global budget payment scheme
Co-payment for outpatient care, inpatient care, and drugs
Characteristics of NHI (2)Characteristics of NHI (2)
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Enrollment EligibilityEnrollment Eligibility
All Citizens
Foreigners with resident permits
Dependents of the aforementioned
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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
Benefit CoverageBenefit Coverage
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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
Benefit CoverageBenefit Coverage
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Premium Contribution SharesPremium Contribution Shares(current premium rate: 4.55%)(current premium rate: 4.55%) Unit:%
Category Government Employer Employee
1st Private-sector Employees 10 60 30
Government Employees __ 70 30
Self-employed / Employers __ __ 100
2nd Union members 40 __ 60
3rd Farmers / Fishermen 70 __ 30
4th Conscripted military personnel
100 __ __
5th Low-income households 100 __ __
6th Veterans 100 __ __
Community groups 40 __ 60
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Calculation of Insurance PremiumCalculation 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)
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Copayment for Outpatient CareCopayment for Outpatient Care Unit:USD
(1 USD = 35 NTD)
Outpatient Care
Emergency Care
Dental Care & Chinese Med.
Drug (20%)
Academic Medical Centers
Through Referral
Without Referral
6 10
13
1. 5
0~6
Regional Hospitals Through Referral Without Referral
4 7
9 1. 5 0~6
District Hospitals/Clinics
Through Referral Without Referral
1.5 2
4. 5
1. 5
0~6
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
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Length of Stay Coinsurance Rate
within 30 days 10%
31 to 60 days 20%
Above 61 days 30%
Coinsurance for Inpatient CareCoinsurance for Inpatient Care(Acute 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).
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Exemptions of CopaymentExemptions 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
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Relief Measures for the Disadvantaged GroupRelief 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
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Development of Payment SystemDevelopment 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)
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Current StatusCurrent Status
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Major Achievements of NHIMajor Achievements of NHI
Universal coverage Easy access Affordable costHigh public satisfactionAcceptable Quality
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99%
1%
Insured Uninsured
Population Covered : 22 .3 million (99%)
Universal Enrollment Universal Enrollment
• Staying abroad• Homeless people are hard to locate
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Easy AccessEasy 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.
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25%
37%
38%
Total revenues in 2006: NT$367billion (US$10.5 billion)
Premium RevenuesPremium Revenues
EmployerEmployer
GovernmentGovernmentInsuredInsured
US$3.9Billion
US$4.0 BillionUS$4.0 BillionUS$2.6 BillionUS$2.6 Billion
(1 USD = 35 NTD)
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35%65%
Total Spending in 2006 : NT$ 423billion payment points (US$12.1 billion)
Medical ExpendituresMedical Expenditures
Outpatient Care
Inpatient Care
US$4.2 Billion
US$7.9 Billion
(1 USD = 35 NTD)
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382.1
361.0352.2
336.8
307.6286.1
285.2
264.9
194.0
241.3 243.6260.5
382.2367.4
352.6337.1
323.3301.8
284.2
285.9
156.8
222.9 237.6
262.0
0
40
80
120
160
200
240
280
320
360
400
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Insurance Revenues
Insurance Cost
Insurance Cost Average growth rate : 5.54%
Insurance Revenues Average growth rate :4.70%
Trend of NHI Financial StatusTrend of NHI Financial StatusUnit: NT$bn
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NHI IC CardNHI IC Card
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Content of IC CardContent of IC Card
NHI IC card
IC Chip Explicit Data
Basic Data SectionHealthcare Data SectionMedical Data SectionHealth Administration Data Section
NameBirth dateID NumberPhotograph (Optional)
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High SatisfactionHigh Satisfaction (1995 ~ 2007.6)
Satisfied (DOH)Satisfied (BNHI)
Dissatisfied (DOH)Dissatisfied (BNHI)
77.50%
64.30%
63.40%71.70%
72.30%
76.60%78.60%77.60%76.30%70.90%
78.50%
71.1%
65.6%63.3% 63.8%
67.2%66.5%
61.0%
50.2%
39.0%
65.4% 68.3% 59.70%
13.30%
36.5%
22.5%
23.4% 22.10%27.80%
34.10%
36.10%
22.10%
11.60%17.00%
29.60%20.1%25.9%
24.2%
24.5%
22.0%
27.0%
47.0%
20.60% 15.90%17.2%
13.60%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Satisf ied Dissatisf ied
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
Premium & Copayment Adjusted
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Http://www.nhi.gov.tw
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Thank you Thank you for your kind attention!for your kind attention!