讀後心得

The health insurance system will implement the "individual hospital global budget" new policy in the northern region in April, which may affect the distribution of medical resources, leading to limitations in patient treatment or increased out-of-pocket expenses. The new system requires hospitals to control annual health insurance points, not exceeding the previous year’s amount. As a result, hospitals may reduce outpatient services, delay checks and surgeries, making it more difficult for patients to seek medical care. Although the health insurance agency will establish monitoring mechanisms to protect public interests, the experience from the southern region indicates that this may lead to tighter medical resources, causing patients to endure longer waiting times and possibly increasing pressure on emergency services. In this situation, hospitals have no choice but to adjust their operational strategies and may even turn towards the out-of-pocket market, resulting in changes in the quality of medical services.

The health insurance system is about to undergo major reforms! Starting in April, major hospitals in the northern region will implement the "Individual Hospital Global Budget" (small global budget) system. Will this affect the allocation of medical resources, leading to limited treatments for patients or increased out-of-pocket expenses? What will be the impact on public rights?

In April of this year, hospitals in the northern region (New Taipei City, Yilan County, Kinmen County, and Lienchiang County) will begin implementing the new small global budget system. To control finances, hospitals will adopt various measures, including reducing outpatient services on Saturdays and holidays or delaying examinations and non-emergency surgeries to prevent exceeding growth rates, which could affect health insurance payments. Although health insurance agencies emphasize the establishment of monitoring mechanisms to grasp the patient admission situation in each hospital and ensure the public’s right to medical access, based on the experiences from the southern region and the Kaohsiung-Pingtung area, this reform may infringe upon the public’s right to medical care, making access to healthcare more difficult. The outcomes of the tug-of-war between policy and convenience remain to be observed.

What is the "Individual Hospital Global Budget"? How does it differ from past systems? The previous health insurance global budget system focused solely on quantity without considering content, leading to competition among hospitals and causing problems of overmedicalization. Since its implementation 22 years ago, the budget gap has continually widened, and issues like drug shortages and the introduction of new drugs and technologies have significantly lagged behind other countries. To address these problems, health insurance agencies in the southern region began implementing the "Individual Hospital Pre-emptive Budget Area Co-management Pilot Plan," requiring each hospital to ensure that their annual health insurance points do not exceed the previous year; otherwise, payments would be reduced or even denied. In simple terms, resources are limited, and doing more will not yield extra returns.

The northern region's hospitals are the last to implement the "small global budget" system among the six regions in the country. Although health insurance agencies have promised that critical illnesses and rare diseases will not be included in the budget, these reforms may still impact the public’s right to medical access. Experts from the Taiwan Society of Healthcare Management have also pointed out that changes in hospital strategies may affect the public’s healthcare rights, especially in situations with limited resources. While the new system has its advantages, such as allowing hospitals to manage resources more effectively, it may also affect the convenience of patient care.

Taking the southern region's implementation as an example, an unnamed regional hospital director indicated that the new calculation method is based on "quarters"; in practice, hospitals still perform normal consultations and checks during the first two months of the quarter, but if an excess is discovered at the end of the quarter, they will adopt contraction strategies, usually limiting the number of outpatients and reducing unnecessary examinations and medications. In other words, patients' needs for medical consultations will be influenced by hospital control.

Moreover, after the implementation of the small global budget system, hospitals may adopt many different control measures. Some hospitals will enforce limits on physicians' outpatient numbers and reduce unnecessary examinations or medications. They may even switch to cheaper medications or delay the timing of non-emergency surgeries. For instance, cataract surgery scheduling that previously could be completed within two weeks may now require a wait of three months or longer.

Scheduling for imaging examinations is similarly grim. The director noted that for imaging tests such as CT scans and MRIs, patients must wait over two months to complete their examinations, and such delays could affect the timely diagnosis and treatment of conditions.

Regarding the increased burden on emergency services due to a surge in cases, an oncologist from a medical center shared his observations: limited outpatient quotas have caused more patients to turn to emergency treatment, which has inadvertently increased the burden on emergency services. A vice president from a local hospital stated that while healthcare point values are stabilizing in the southern region, the northern region may face many issues in the future, such as difficulty in making appointments, extended waiting times for examinations, and tight hospital bed availability due to receiving patients from various areas.

As the new system approaches, how should the public psychologically adjust? The hospital vice president pointed out that Taiwan's healthcare has always been very convenient, but the implementation of new policies will change all of that. For arranging non-emergency surgeries, he suggested that patients seek consultation at hospitals during the first two months of each quarter, which may reduce the risk of delays. "The policy has been confirmed and must be adjusted in accordance with the changes."