Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
The health insurance premium rate adjustment has sparked criticism about wasteful health insurance expenditures. On the 11th, the Central Health Insurance Bureau introduced multiple cost-saving measures. Individuals who visit outpatient clinics over 100 times a year will have their cards "locked," restricting their access to medical facilities. Doctors found guilty of defrauding the health insurance system will be permanently "blacklisted" after their second suspension. The Health Insurance Bureau is tightening controls and also urging the public to reduce unnecessary medical visits, aiming to address the financial challenges of the health insurance system through dual approaches.
By the end of the year, the health insurance deficit is expected to exceed NT$100 billion, with monthly revolving loans from banks nearing NT$160 billion, making a premium rate adjustment urgent. Health Insurance Bureau Director Zheng Shouxia held a press conference yesterday, announcing several cost-saving measures and admitting that these measures would inevitably affect some people's medical habits. However, after 15 years of operation, without stricter measures, even higher premiums would not suffice.
**High-Frequency Patients Restricted to Specific Facilities**
The Health Insurance Bureau’s ten major cost-saving measures, announced yesterday, target both healthcare providers and the public. The "Six Major Anti-Fraud Measures" impose stricter controls on the medical sector, while the "Four Major Requirements" aim to reduce wasteful medical visits by the public.
The most impactful measure for the public is the "card-locking" policy for high-frequency patients. Cai Shuling, head of the Health Insurance Bureau’s Medical Management Division, stated that excluding those with major illnesses, 35,000 people visited outpatient clinics over 100 times last year, with 382 exceeding 200 visits. Starting immediately, those with over 100 outpatient visits will have their cards locked for management. If, after counseling and follow-ups, patients continue to seek unnecessary medical care, their cards will be locked starting in October, limiting them to specific healthcare facilities.
Previously, the health insurance system lacked an "exit mechanism" for non-compliant medical institutions and doctors. It was common for hospitals to reopen under a different name at the same address after being suspended, or for doctors to rejoin the system after serving a suspension for fraud. Some even hired doctors over 75 as figureheads to claim insurance fees without actual practice.
**Doctors Defrauding Insurance Banned for Life**
Zheng Shouxia stated that in the future, if fraud is detected, the defrauded amount will be deducted from the institution’s next-year budget. Repeat offenders among doctors and hospitals will be permanently blacklisted through legal amendments.
For chronic disease patients, the public is encouraged to bring their medication bags to appointments so doctors can track current prescriptions and avoid duplicate medications or adverse drug interactions.
The health insurance system will also conduct its seventh drug price survey, requiring pharmaceutical suppliers to submit quarterly transaction reports. Drug pricing will move toward "same ingredient, same quality, same price." Additionally, starting in April, non-TCM practitioners performing therapies like massage will no longer be reimbursed.
Source: http:/ / life. chinatimes. com/ 2……0302+112010031200046,00. html
NHI Cost Control: Cards Blocked after 100 Annual Visits, Repeat Offender Doctors Permanently Banned
By the end of the year, the health insurance deficit is expected to exceed NT$100 billion, with monthly revolving loans from banks nearing NT$160 billion, making a premium rate adjustment urgent. Health Insurance Bureau Director Zheng Shouxia held a press conference yesterday, announcing several cost-saving measures and admitting that these measures would inevitably affect some people's medical habits. However, after 15 years of operation, without stricter measures, even higher premiums would not suffice.
**High-Frequency Patients Restricted to Specific Facilities**
The Health Insurance Bureau’s ten major cost-saving measures, announced yesterday, target both healthcare providers and the public. The "Six Major Anti-Fraud Measures" impose stricter controls on the medical sector, while the "Four Major Requirements" aim to reduce wasteful medical visits by the public.
The most impactful measure for the public is the "card-locking" policy for high-frequency patients. Cai Shuling, head of the Health Insurance Bureau’s Medical Management Division, stated that excluding those with major illnesses, 35,000 people visited outpatient clinics over 100 times last year, with 382 exceeding 200 visits. Starting immediately, those with over 100 outpatient visits will have their cards locked for management. If, after counseling and follow-ups, patients continue to seek unnecessary medical care, their cards will be locked starting in October, limiting them to specific healthcare facilities.
Previously, the health insurance system lacked an "exit mechanism" for non-compliant medical institutions and doctors. It was common for hospitals to reopen under a different name at the same address after being suspended, or for doctors to rejoin the system after serving a suspension for fraud. Some even hired doctors over 75 as figureheads to claim insurance fees without actual practice.
**Doctors Defrauding Insurance Banned for Life**
Zheng Shouxia stated that in the future, if fraud is detected, the defrauded amount will be deducted from the institution’s next-year budget. Repeat offenders among doctors and hospitals will be permanently blacklisted through legal amendments.
For chronic disease patients, the public is encouraged to bring their medication bags to appointments so doctors can track current prescriptions and avoid duplicate medications or adverse drug interactions.
The health insurance system will also conduct its seventh drug price survey, requiring pharmaceutical suppliers to submit quarterly transaction reports. Drug pricing will move toward "same ingredient, same quality, same price." Additionally, starting in April, non-TCM practitioners performing therapies like massage will no longer be reimbursed.
Source: http:/ / life. chinatimes. com/ 2……0302+112010031200046,00. html