NHI Trying to Drive Patients to Smaller Hospitals|強制落實分級 大醫院不減診不給健保

To realize tiered medical care, and to prevent over crowding at the major hospitals, the National Health Insurance Administration is calling on hospitals that are regional and above, to reduce their clinic patients by 2 percent every year and at least 10 percent within five years starting this month. If hospitals can't or won't do so, they will not get NHI payments.


Many people head to major hospitals at the drop of a hat no matter how minor their condition. As a result, Taiwan's top hospitals are overcrowded. The National Health Insurance Administration has ordered regional and above hospitals to reduce outpatient patient load by 2 percent every year and by at least 10 percent within five years starting this month. Hospitals that don't comply will no longer receive NHI payments. An estimated 110 hospitals and 800,000 patients per year will be affected.

Regional and above hospitals will have to reduce outpatient load by 800,000 a year. We believe these are all patients that can be sent back to clinics and small hospitals for treatment.

The NHIA says it has used various "reward and punishment" methods in recent years to remove patients with minor conditions from large hospitals, including raising treatment costs at major hospitals and lowering treatment costs for transfer patients. As these methods have not had much of an impact, the NHIA ultimately decided to go with the new withholding payments method to force large hospitals to transfer patients with chronic or minor conditions to lower-tier hospitals and clinics.

There will be integration and alliances with clinics so that patients with minor conditions can be transferred down to the next lower tier for medical care.

What's to stop hospitals from picking and choosing patients? I can reduce patient load by 2 percent, no problem. I'll just keep the patients with minor and chronic conditions because they earn the hospital more money.

The NHIA says the new measure targets hospitals and not patients, and the fate of large hospitals rests in their own hands. The agency also says the measure does not affect the medical rights of patients in any way and patients need to trust clinic doctors more. It also called on patients to stop crowding large hospitals every time they get sick with minor illnesses.