Taiwan Medical Community Concerned About The Medical Payment Reformation

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Translated by Shin-wei Chang and Olivia Yang

On January 29, the Ministry of Health and Welfare has announced that the “Tw-DRGs” will officially start on March 1. The current pay-as-you-go system pays for medical treatments that are actually performed on patients. However, the DRG (Diagnosis Related Group) system will compensate the same amount of money for patients diagnosed with the same disease. Critics are concerned that after Tw-DRGs starts, hospitals are likely to avoid spending extra money on patients with higher risk and more serious conditions, and they might become unwanted patients that all hospitals hope to get rid of.

The payment items of “Tw-DRGs” include up to 1,262 medical services, and the total amount of payment will cover 58% of inpatient expenses. According to the Ministry of Health and Welfare, inpatients are grouped by their diagnoses, surgeries, treatments, ages and so on. “Tw-DRGs” regulates payment points based on use of medical resources in each group. Extra payments are also applicable to certain treatments.

However, critics worry that patients with more critical conditions might not be admitted by hospitals because of the DRG system. But the National Health Insurance Administration argues that based on the data in 2014, statistics including the average number of days of hospitalization, revisit rate, readmission rate and so on has improved. This not only indicates that the effectiveness of medical treatment has made progress, but also corresponds to the goal of this medical payment reformation.

In addition, based on the medical costs within the hospital DRG filing limit, the National Health Insurance Administration conducted a financial impact assessment that shows the reformation will have a limited impact on hospital finances.

Regarding criticisms from the medical community, Pang Yi-ming, department head of the National Health Insurance Administration, says the DRGs system adopts a rolling review process and will continue including opinions of the medical community. After the system is fully implemented, a new regulation will also follow that allows doctors to file for medical costs on reasonable grounds, such as treating rare diseases.

Regarding this, doctors and people from the medical community have said on Facebook that the reformation shows the government has no integrity. A doctor from National Taiwan University Hospital also says he wouldn’t be surprised if the government sold the health of the people to foreign financial groups one day.

Edited by Olivia Yang

Sources:
Liberty Times
CNA
Apple Daily
ETtoday