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National Health Insurance: Poor Quality with Higher Premium Rates

Increase in national health insurance premium did not boost the quality of medical care. The most criticized problem of all is the lack of transparency in the availability of national health insurance-covered beds. The undersupply of insurance-covered hospital beds forced patients to either choose out-of-pocket patient beds and pay the price difference or embarrassingly remain in the hallway outside emergency rooms to wait for an opening. The Control Yuan launched an investigation to examine the problem. (Case no. 0990800256)

The Department of Health (now the Ministry of Health and Welfare) did not publicize information on “patient beds covered by national health insurance and out-of-pocket patient beds in metropolitan areas”, forcing some patients to resort to “favors” from people with influence to secure a hospital bed and undermining trust between patient and doctor. In addition, the past three years saw little or no improvement in the ratio of patients who were forced to temporarily stay in the emergency rooms for two days or more as a result of hospital bed shortage. As the Department of Health (DOH) failed to specify the timetable for improvement by amending regulations, hospitals procrastinated in meeting the legal ratio of national health insurance-covered patient beds and consolidating hierarchic referral and family doctor systems. Moreover, the established “hospital accreditation public information” section was found with wrong statistics. The CY proposed corrective measures to the DOH.

In response to the CY’s redress, the DOH amended Articles 32 and 33 of the Regulations Governing Contracting and Management of National Health Insurance Medical Care Institutions to increase the ratio of insurance-covered beds (75% and above for public hospitals; 60% and above for private ones) and provide online information on the total number of out-of-pocket and insurance-covered beds, along with daily availability of all types of beds and their legal ratios. The DOH promised to educate “appropriate patient behavior” and encourage the public to visit local clinics or small hospitals for minor illnesses rather than crowing into big-name hospitals faraway. The DOH also set up a” hospital development award” to encourage better quality care and services from small medical facilities.