Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
【China Times, Zhu Zhenkai / Taipei Report】2009.03.17
Taiwan's annual National Health Insurance (NHI) expenditure of NT$460 billion is entirely decided by the 27 members of the "NHI Expenditure Allocation Committee" (Expenditure Committee), equivalent to each member controlling NT$17 billion. However, the committee's allocation meetings are not open to the public, and "payer representatives" even include pharmaceutical company owners. The Taiwan Healthcare Reform Foundation (THRF) strongly criticized this as a "black-box agency" and filed a petition with the Control Yuan yesterday.
The amount of NHI fees to be spent each year is determined through negotiations by the Expenditure Committee in the previous year. Every decision made by the committee directly affects how much the public must pay for NHI, wielding enormous influence.
THRF CEO Liu Mei-chun pointed out that Taiwan's NHI budget totals NT$460 billion, yet the Expenditure Committee has only 27 representatives, meaning each member controls an average of NT$17 billion—equivalent to the influence of a legislator over the government's total budget.
Liu Mei-chun stated that what’s alarming is that the negotiation meetings of these 27 members lack transparency and openness. For years, the Legislative Yuan’s Budget Center has criticized the committee as a "black-box agency not approved by the Legislative Yuan through three readings." The Legislative Yuan, once dubbed the "backroom congress," has long since implemented public transcripts of speeches, and even cross-party negotiations are now open. The Expenditure Committee should also provide transparent mechanisms for public oversight.
THRF Deputy CEO Liu Shu-chiung further noted that while the committee’s membership is divided equally among government, payer, and healthcare group representatives, appearing balanced on the surface, investigations into the members’ backgrounds revealed that among the payer representatives, one is Huang Ming-ho, president of the Show Chwan Healthcare System, and another is Tseng Yi-ching, a pharmaceutical company board member. This blatantly disregards conflict-of-interest principles, effectively increasing healthcare group representation to 40%, yet the Department of Health still approved their appointments.
Liu Shu-chiung cited the highly controversial "drug price survey" case as an example. Investigations found a staggering NT$15 billion surplus from drug procurement price differences, which, by regulation, should have been entirely allocated as a "safety reserve" to benefit the public. However, after discussions, the Expenditure Committee allocated NT$12 billion to the medical sector, and the remaining NT$3 billion flowed back to the sector the following year—effectively diverting the entire NT$15 billion drug price black hole into the medical industry.
Liu Mei-chun emphasized that the Expenditure Committee should follow the Legislative Yuan’s model by keeping detailed meeting records and publishing them online within a week. All agendas should be announced one week before meetings to allow the public to voice opinions in advance, preventing controversial issues from being smuggled in as last-minute proposals.
Control Yuan member Huang Huang-hsiung, who accepted the petition, stated that since NHI is mandatory, the lack of transparency in decision-making is indeed unreasonable. Administrative agencies should amend relevant regulations, and the Control Yuan will also launch an investigation.
Source: http://health. chinatimes. com/ contents. aspx? cid=5,63& id=5261
【China Times Health / Yang Gefei Report】2009.03.17
Taiwan's National Health Insurance (NHI) will mark its 14th anniversary this March. Yesterday, the Taiwan Healthcare Reform Foundation (THRF) called on Premier Liu Chao-shiuan to present the NHI with a "birthday gift" that ensures its sustainable operation—speeding up the transparency and legalization of the "NHI Fee Agreement Committee," which oversees an annual medical expenditure of NT$460 billion.
In just a few days, 76 labor, social welfare, patient advocacy, and medical groups have joined the petition, along with numerous scholars in law, administration, and medicine, as well as professionals from the Hsinchu Science Park.
Yesterday afternoon, the THRF submitted the petition to the Executive Yuan, expressing public demands for NHI reform. Subsequently, the petitioning groups proceeded to the Control Yuan to file a complaint, where Control Yuan member Huang Huang-hsiung received them.
The THRF's petition advocates two main demands for "transparency in the NHI Fee Agreement Committee": First, meeting minutes should follow the Legislative Yuan's standards, providing detailed records of discussions and publishing them online within a week after confirmation. Agendas and proposals should also be announced online a week in advance, allowing the public to voice opinions beforehand and preventing controversial items from being slipped in as last-minute proposals.
Recently, the Department of Health (DOH) proposed a "1.5-generation NHI" reform, which was later postponed after Premier Liu instructed that public opinion be prioritized and cost-saving measures be implemented first. The THRF elevated the issue, urging the Executive Yuan to address the lack of transparency and public alignment in the DOH's NHI decision-making process, as well as the opaque and non-legalized structure of the NHI Fee Agreement Committee.
An increasing number of people struggle to pay NHI premiums. However, if the committee members responsible for deciding the annual NHI budget generously increase spending by 3–5% each year, allocating funds to the medical sector without clear public oversight, the NHI could eventually face bankruptcy.
Liu Shu-chiung, THRF deputy executive director and associate professor at National Taiwan University's Department of Social Work, highlighted the excessive power of committee members. She noted that while a single legislator can only influence NT$500 million of the DOH's budget, each committee member wields an average influence of NT$17 billion.
Liu pointed out that even the Legislative Yuan, once criticized as a "backroom congress," now publishes meeting minutes online for public review, including cross-party negotiations. Yet, the NHI Fee Agreement Committee remains opaque, and the Executive Yuan must no longer ignore this issue.
More alarmingly, while one-third of the committee members are supposed to represent payers and scholars, some are actually hospital or pharmaceutical company owners, blatantly violating conflict-of-interest principles—yet the DOH still approves their appointments.
Take the controversial "drug price survey" case as an example. After investigations, it was discovered that up to NT$15 billion in savings from drug procurement price differences should have been returned to the NHI's safety reserve for public benefit. However, after several committee discussions, only NT$3 billion was allocated for quality improvement, with the rest returned to the medical sector.
Frustratingly, the entire meeting record totaled just over 7,000 words—each word worth over NT$2 million—making it impossible for the public to understand the decision-making basis. Now, amid an economic downturn, with the NHI demanding premium hikes and hospitals claiming financial strain, the public is left footing the bill—understandably, they are unwilling to accept this.
Source: http://health. chinatimes. com/ contents. aspx? cid=5,63& id=5269
How the $460 Billion Health Insurance Fund is Spent Remains Undisclosed
Taiwan's annual National Health Insurance (NHI) expenditure of NT$460 billion is entirely decided by the 27 members of the "NHI Expenditure Allocation Committee" (Expenditure Committee), equivalent to each member controlling NT$17 billion. However, the committee's allocation meetings are not open to the public, and "payer representatives" even include pharmaceutical company owners. The Taiwan Healthcare Reform Foundation (THRF) strongly criticized this as a "black-box agency" and filed a petition with the Control Yuan yesterday.
The amount of NHI fees to be spent each year is determined through negotiations by the Expenditure Committee in the previous year. Every decision made by the committee directly affects how much the public must pay for NHI, wielding enormous influence.
THRF CEO Liu Mei-chun pointed out that Taiwan's NHI budget totals NT$460 billion, yet the Expenditure Committee has only 27 representatives, meaning each member controls an average of NT$17 billion—equivalent to the influence of a legislator over the government's total budget.
Liu Mei-chun stated that what’s alarming is that the negotiation meetings of these 27 members lack transparency and openness. For years, the Legislative Yuan’s Budget Center has criticized the committee as a "black-box agency not approved by the Legislative Yuan through three readings." The Legislative Yuan, once dubbed the "backroom congress," has long since implemented public transcripts of speeches, and even cross-party negotiations are now open. The Expenditure Committee should also provide transparent mechanisms for public oversight.
THRF Deputy CEO Liu Shu-chiung further noted that while the committee’s membership is divided equally among government, payer, and healthcare group representatives, appearing balanced on the surface, investigations into the members’ backgrounds revealed that among the payer representatives, one is Huang Ming-ho, president of the Show Chwan Healthcare System, and another is Tseng Yi-ching, a pharmaceutical company board member. This blatantly disregards conflict-of-interest principles, effectively increasing healthcare group representation to 40%, yet the Department of Health still approved their appointments.
Liu Shu-chiung cited the highly controversial "drug price survey" case as an example. Investigations found a staggering NT$15 billion surplus from drug procurement price differences, which, by regulation, should have been entirely allocated as a "safety reserve" to benefit the public. However, after discussions, the Expenditure Committee allocated NT$12 billion to the medical sector, and the remaining NT$3 billion flowed back to the sector the following year—effectively diverting the entire NT$15 billion drug price black hole into the medical industry.
Liu Mei-chun emphasized that the Expenditure Committee should follow the Legislative Yuan’s model by keeping detailed meeting records and publishing them online within a week. All agendas should be announced one week before meetings to allow the public to voice opinions in advance, preventing controversial issues from being smuggled in as last-minute proposals.
Control Yuan member Huang Huang-hsiung, who accepted the petition, stated that since NHI is mandatory, the lack of transparency in decision-making is indeed unreasonable. Administrative agencies should amend relevant regulations, and the Control Yuan will also launch an investigation.
Source: http://health. chinatimes. com/ contents. aspx? cid=5,63& id=5261
Health Reform Group Slams: NHI Fee Negotiation Committee as Illegitimate Body
Taiwan's National Health Insurance (NHI) will mark its 14th anniversary this March. Yesterday, the Taiwan Healthcare Reform Foundation (THRF) called on Premier Liu Chao-shiuan to present the NHI with a "birthday gift" that ensures its sustainable operation—speeding up the transparency and legalization of the "NHI Fee Agreement Committee," which oversees an annual medical expenditure of NT$460 billion.
In just a few days, 76 labor, social welfare, patient advocacy, and medical groups have joined the petition, along with numerous scholars in law, administration, and medicine, as well as professionals from the Hsinchu Science Park.
Yesterday afternoon, the THRF submitted the petition to the Executive Yuan, expressing public demands for NHI reform. Subsequently, the petitioning groups proceeded to the Control Yuan to file a complaint, where Control Yuan member Huang Huang-hsiung received them.
The THRF's petition advocates two main demands for "transparency in the NHI Fee Agreement Committee": First, meeting minutes should follow the Legislative Yuan's standards, providing detailed records of discussions and publishing them online within a week after confirmation. Agendas and proposals should also be announced online a week in advance, allowing the public to voice opinions beforehand and preventing controversial items from being slipped in as last-minute proposals.
Recently, the Department of Health (DOH) proposed a "1.5-generation NHI" reform, which was later postponed after Premier Liu instructed that public opinion be prioritized and cost-saving measures be implemented first. The THRF elevated the issue, urging the Executive Yuan to address the lack of transparency and public alignment in the DOH's NHI decision-making process, as well as the opaque and non-legalized structure of the NHI Fee Agreement Committee.
An increasing number of people struggle to pay NHI premiums. However, if the committee members responsible for deciding the annual NHI budget generously increase spending by 3–5% each year, allocating funds to the medical sector without clear public oversight, the NHI could eventually face bankruptcy.
Liu Shu-chiung, THRF deputy executive director and associate professor at National Taiwan University's Department of Social Work, highlighted the excessive power of committee members. She noted that while a single legislator can only influence NT$500 million of the DOH's budget, each committee member wields an average influence of NT$17 billion.
Liu pointed out that even the Legislative Yuan, once criticized as a "backroom congress," now publishes meeting minutes online for public review, including cross-party negotiations. Yet, the NHI Fee Agreement Committee remains opaque, and the Executive Yuan must no longer ignore this issue.
More alarmingly, while one-third of the committee members are supposed to represent payers and scholars, some are actually hospital or pharmaceutical company owners, blatantly violating conflict-of-interest principles—yet the DOH still approves their appointments.
Take the controversial "drug price survey" case as an example. After investigations, it was discovered that up to NT$15 billion in savings from drug procurement price differences should have been returned to the NHI's safety reserve for public benefit. However, after several committee discussions, only NT$3 billion was allocated for quality improvement, with the rest returned to the medical sector.
Frustratingly, the entire meeting record totaled just over 7,000 words—each word worth over NT$2 million—making it impossible for the public to understand the decision-making basis. Now, amid an economic downturn, with the NHI demanding premium hikes and hospitals claiming financial strain, the public is left footing the bill—understandably, they are unwilling to accept this.
Source: http://health. chinatimes. com/ contents. aspx? cid=5,63& id=5269