NIHA to cut reimbursements for medical treatment overseas

2017/12/05 19:03:16 fontsize-small fontsize-default fontsize-big
CNA file photo

CNA file photo

Taipei, Dec. 5 (CNA) The National Health Insurance Administration (NHIA) said Tuesday that starting next year, it will adjust the standard used to calculate the maximum reimbursement paid to Taiwan nationals who receive urgent or emergency medical care overseas.

When the new standard is adopted with effect from Jan. 1, 2018, reimbursements will be calculated based on the average cost of similar medical care at Taiwan's various levels of health facilities, the NHIA said.

Currently reimbursements to people with National Health Insurance (NHI) coverage who receive urgent or emergency health care overseas are calculated based on the cost of care at Taiwan's medical centers, its top tier health institutions.

The maximum reimbursement in various categories of care is assessed every three months and this will continue when the new formula is adopted, NHIA official Lin Pao-feng (林寶鳳) said.

One of the problems the NHIA has identified is attempted fraud by some Taiwanese nationals in collaboration with certain medical clinics in China to collect reimbursements, Lin said.

When the new formula is put into effect next January, the cap on reimbursements for an outpatient visit will drop from NT$2,001 to NT$865, for an emergency room visit from NT$3,636 to NT$2,412, and for hospitalization from NT$7,535 to NT$5,295 per night, she said.

With the implementation of the new system, the NHIA is expected to save approximately NT$100 million per year, she said.

According to Lin, last year the NHIA received 130,000 applications for reimbursements for overseas medical treatment, with payments amounting to around NT$377 million (US$12.6 million).

The main conditions treated overseas in 2016 were acute upper respiratory tract infection, acute bronchitis and renal failure, according the NHIA.

(By Chang Ming-hsuan and William Yen)
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