Public grievances against overseas Taiwanese citizens seen as abusing the healthcare system have prompted the government to reform the regulations of National Health Insurance (NHI) payments.
The new rules, as a part of the government's efforts to reduce the long-run deficit in the budget for the national healthcare system, are expected to affect more than 170,000 Taiwanese people living abroad.
Now, Taiwanese citizens who have lived in foreign countries for six months to two years may suspend their monthly premium payments and get reinsured upon returning to Taiwan. NHI regulations apply to overseas Taiwanese based on their duration of residence abroad.
After the reforms, the National Health Insurance Administration (NHIA) said such a rule will be scrapped and this group will be obliged to monthly payments for the insurance. Typically, it is mandatory for Taiwanese citizens to enroll in the NHI, and those who fail to do so receive a fine.
NHIA statistics revealed that over 910,000 suspended NHI payments last year for their stay of less than two years abroad. They were exempted from paying a total of NT$448 million (US$16 million) to the insurance system.
Meanwhile, those who live overseas for more than two years and have their household registration automatically cancelled will be allowed to suspend their NHI payments, but the coverage of the insurance will resume only six months after their return to Taiwan, NHIA said.
If they wish to be covered by insurance immediately, a new regulation allows them to pay back the premiums for the period when their coverage is suspended. The maximum back payment is capped at five months.
NHIA plans to discuss the new measures with the Overseas Community Affairs Council this week and they are likely to take effect next year, said Lee Po-chang, Director General of the cabinet-level agency responsible for managing the healthcare system.
Reducing costs
Calls for the revision to rules of NHI payments have a political aspect, with Taiwanese public figures living in China who use local healthcare services being a subject of controversy.
Huang An, a Taiwanese comedian based in China, returned to Taiwan for heart surgeries several times. In 2016, the BBC reported that he paid NT$749 (US$23) each month for the insurance, while Huang’s annual income exceeds NT$10 million (US$300,000).
One of Huang’s trips for medical treatment cost the NHI an estimated NT$800,000 (US$24,000). Many in Taiwan accuse him of abusing national healthcare resources.
Another figure who sparked public outrage is Fanny Liu, a Taiwanese singer, who once said she will leave China for Taiwan to receive treatment if she contracts the novel coronavirus. She called the proposed reforms a “cheap shot” by the government of Democratic Progressive Party.
The current NHI regulations are widely criticized for allowing Taiwanese who live abroad for a long time to temporarily resume NHI coverage by paying a small premium after returning to Taiwan whenever they need treatment.
Chen Shih-chung, Minister of Health and Welfare, said the lowest level of premium should not apply to well-heeled Taiwanese citizens who live abroad.
In the NHI system, the level of income determines the level of premium. Overseas Taiwanese who do not work and earn wages in Taiwan are automatically considered to have no income and therefore allowed to pay the lowest premium possible, NT$749 (US$23).
Despite the difficulty, Chen said the wages these Taiwanese nationals earn have to be taken into consideration when it comes to deciding the level of premium.
Lee, who heads the NHIA, said NHI reforms start from preventing waste. “If we can save the money we would have otherwise wasted, it can go to cancer or rare disease treatment,” which is not fully covered by the insurance.
Increasing revenue
While some have appealed to the government to rectify the status quo that allows overseas citizens like Huang to pay premiums disproportionate to the cost of the care they receive in Taiwan, the NHIA has been mulling over raising the premiums for the NHI to ease the burden of deficit. It is the first such raise in ten years.
By the end of this year, the NHI expects to run a NT$67 billion (US$2.3 billion) deficit, with its reserve fund hitting a new low, worth 1.88 months of premium revenue.
The current fee for NHI is 4.69% of the insured amount, defined by monthly wage level. The rate is likely to be lifted to 4.97%, or somewhere between 5.52% to 5.55%.
But civil groups are calling on the NHIA to give the decision a second thought, considering the economic impact of the Covid-19 pandemic.
The Consumers’ Foundation urged the government to “feel the suffering of the people” by minimizing the raise and recommended imposing a new tax on alcohol or sugar to create additional revenue streams for the NHI.
The decision to raise the premiums is understandable, but the government has to respond to the issues that the public and healthcare officials care about, said the Taiwan Healthcare Reform Foundation, a non-profit organization that promotes patient rights, such as remote healthcare and intensive care for children.
As the payer, people have to not only have a say in how the government uses the premiums, but be informed of what they can gain after a raise, the foundation added.
The government prefers the proposal that “puts the least burden on both the employer and the employed,” according to people familiar with the matter. It plans to decide on the proposal by January 1, 2021.
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TNL Editor: Bryan Chou, Nicholas Haggerty (@thenewslensintl)
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