Efficiency and Efficacy of Catastrophic Illness Coverage under NHI in Taiwan

Presenter: Chung-Fu Lan, Yang-Ming University

Abstract

Rationale: Since launched in 1995, Taiwan health insurance (NHI) in Taiwan had significantly narrowed health disparity by offering equal access to affordable medical care services to all citizens. One important effort to achieve this goal was extending the insurance coverage to protect people with selected health conditions that may lead to catastrophic financial burden and subsequent impoverishment. Yet catastrophic health expenditures, including cancer and renal diseases, are expected to increase rapidly with population aging in addition to the extended coverage.

Objective: This paper aimed to evaluate the performance of catastrophic illness coverage policy in Taiwan's NHI, and to explore potential ways of improving efficiency and efficacy in health resource uses and allocation.

Methodology: We obtained databases of NHI, "catastrophic illnesses insurance certificates", death certificates, and some selected patients' characteristics datum from 1995 to 2006. We have employed regression analysis to explore variables associated with catastrophic health expenditure, especially the effects of aging, case numbers of different catastrophic conditions, level of care, and medical care costs of co-morbidities of the selected catastrophic illnesses. In addition, we also analyzed and compared survival rates of covered catastrophic conditions.

Results: Twenty four groups of conditions were recognized as catastrophic illness or injury covered under NHI scheme and 217,906 diagnostic certificates had been issued in 1995. The numbers markedly increased to 30 groups of conditions and 757,571 certificates in a decade, accounting for 31% of insurance reimbursed expenditure increases in 2007. Groups of catastrophic conditions showed significant difference in medical expenses and survival rates, interfering with age and level of care.

Conclusion: Diverse survival rates across catastrophic conditions may suggest advanced treatment does not improve outcomes significantly for some illness. Further investigation should be conducted to reconsider the coverage for those conditions with poorer outcomes, and the possibilities of other appropriate approaches for catastrophic coverage.