NTU Hospital Head: NHI Should Also Be Reformed for Insurance Payouts for Day Surgery

(CNA, Taipei, June 10, Reporter: Shen Yao-yao) The Financial Supervisory Commission (FSC) is set to review insurance payouts for day surgeries and other procedures. Although Minister of Health and Welfare Shih Chung-liang believes this is a win-win-win situation, National Taiwan University Hospital (NTUH) Superintendent Yu Chung-jen has called for a discussion and adjustment of the National Health Insurance's (NHI) Diagnosis-Related Group (DRG) payment model, warning that day surgery could otherwise be difficult to implement.

Many current medical insurance policies still require 'hospitalization' as a prerequisite for claims. The FSC is scheduled to meet with insurance companies this afternoon to conduct a comprehensive review of medical insurance claim rules, focusing on three major issues: the shift from inpatient to outpatient care, day surgery, and acute care at home, to consider whether policy benefits can keep up with medical trends.

Minister of Health and Welfare Shih Chung-liang, speaking to the media before attending the Legislative Yuan's Social Welfare and Environmental Hygiene Committee this morning, stated that they are actively communicating with the FSC regarding the practice of requiring hospitalization for related treatments under commercial medical insurance. He emphasized that this is a 'win-win-win' approach: medical costs can be reduced, patients will not be denied benefits due to changes in care models, and hospitals can improve bed utilization and alleviate staffing issues.

NTUH Superintendent Yu Chung-jen affirmed this, stating frankly that due to current claim conditions, many patients request hospitalization even for examinations, which 'makes no sense at all.' This is especially true for high-cost tests like next-generation sequencing (NGS), where the patient's financial burden can be significant without commercial insurance, even with partial NHI coverage.

Speaking to the media at an NTUH event, Yu Chung-jen said that the subjects of these tests are not the patients themselves but their tissues or blood. Yet, to get reimbursed, patients 'are hospitalized even just for a blood draw, which is unreasonable and causes clinical difficulties.' If the commercial insurance system makes a breakthrough, hospital clinical procedures could be comprehensively reviewed.

However, even with a breakthrough in commercial insurance, the current NHI system still requires patients to be hospitalized to receive benefits, which is an obstacle to the new day surgery system. Yu explained that many surgeries, including cataract and hemorrhoid surgeries, can already be shifted to outpatient clinics, but many are stuck due to insurance issues. In addition to policy adjustments, he hopes that the NHI's Diagnosis-Related Group (DRG) payment system can also be adjusted accordingly.

He emphasized that if commercial insurance claims and the NHI benefit model are relaxed, allowing hospitals to adjust their surgical procedures, it is judged that this will be of great help in alleviating pressure on hospital beds. (Editor: Chang Ming-kun) 1150610