讀後心得

The healthcare system will implement the new "small total amount" policy in hospitals in the northern district in April, which will affect the allocation of medical resources and the treatment situation for patients. Hospitals may reduce outpatient services on Saturdays and holidays and delay examinations and non-emergency surgeries in order to control finances. Although the National Health Insurance Administration has promised to establish a monitoring mechanism, previous implementation experiences show that medical resources may become even tighter, potentially impacting patients' rights to medical care. Hospitals will face pressure to control budgets, possibly adopting restrictive strategies that will affect patients' access to medical care, lengthen waiting times, and even increase burdens on emergency services. The public needs to prepare psychologically and adapt to the upcoming changes.

The healthcare system is about to undergo a significant transformation! Starting in April, major hospitals in the northern region will implement the "Individual Hospital Global Budget" (small global budget) system. This could affect the allocation of medical resources, leading to restrictions on patient treatments or increased out-of-pocket expenses. How will the public's rights be impacted?

In April this year, hospitals in the northern region (including Taipei, New Taipei, Yilan, Kinmen, and Lienchiang) will officially implement the new small global budget system. To control financial conditions, hospitals may adopt measures such as reducing outpatient services on weekends and holidays, delaying screenings and non-emergency surgeries, to avoid exceeding growth rates, which could impact healthcare benefits. Although the National Health Insurance Administration emphasizes that a monitoring mechanism will be established to track patient admissions at each hospital and ensure the public's right to medical care, based on the implementation experiences in the southern region and Kaohsiung-Pingtung area, this change may harm the public's right to healthcare and make seeking medical care more difficult, with the outcome of the tension between policy and convenience still to be observed.

The definition of the individual hospital global budget differs from the past system where the former National Health Insurance global budget system only focused on the increase or decrease in quantity without considering content, leading to competition among different hospitals and raising questions about over-treatment. Since the implementation of this system 22 years ago, the budget gap has continually widened, and issues such as drug shortages and the pace of introducing new drugs and new technologies have significantly lagged behind countries like Japan and South Korea. To address these challenges, the National Health Insurance Administration has implemented the "Individual Hospital Preliminary Budget Co-management Pilot Program" starting in the southern region, requiring each hospital’s annual National Health Insurance points not to exceed the previous year. Exceeding this limit will result in discounts or even denial of benefits, known as the "haircut" policy. In simple terms, resources are fixed, and doing more will not lead to more funding.

Hospitals in the northern region are the last to implement the "small global budget" system among the six regions of Taiwan. Although the National Health Insurance Administration states that emergency cases and rare diseases will not be included in budget considerations and will not affect patient rights, the medical model of treating patients on demand will no longer exist.

Medical management experts point out that changes in hospital operational strategies may affect the public's right to medical care, especially in situations with limited resources. The new system may allow hospitals to manage resources more effectively, thereby improving financial control, but every system has its pros and cons. Experts believe that the small global budget system may lead hospitals to consider adjustments in operational models, such as limiting the number of appointments, adjusting the scheduling of exams, or delaying non-emergency surgeries, which could disrupt the accustomed "seek care any time" model.

Regarding the potential impacts of the new system, using hospitals in the southern region as an example, a regional hospital dean who wished to remain anonymous stated that the small global budget system of the National Health Insurance Administration is calculated quarterly; however, in the first two months of each quarter, outpatient services at hospitals still operate normally. Yet at the end of the quarter, they may find themselves exceeding capacity and have no choice but to limit services. The usual practice is to restrict the number of outpatient visits, stop proactively scheduling follow-up appointments with patients, and reduce unnecessary medication and testing. Consequently, if patients want to seek care or undergo examinations, they must rely on the hospital's capacity for accepting patients.

The dean further pointed out that the implementation of the small global budget system has resulted in different control methods among hospitals; some hospitals may require specialists to reduce outpatient visits, and accordingly cut back on diagnostics and prescriptions, or due to cost considerations, may replace medications with cheaper alternatives on a large scale or delay scheduling for non-emergency surgeries. For example, the waiting time for cataract surgery has increased from about two weeks to at least three months or even longer.

In terms of imaging examinations, such as CT scans, MRIs, and ultrasounds, patients may also wait over two months. Such delays not only cause patients to endure long waiting times but may also affect the timely diagnosis and treatment of medical conditions.

According to the vice president of a regional hospital in Pingtung, the small global budget has been implemented in the Kaohsiung-Pingtung area for two years, forcing hospitals to grapple with absorbing the "haircut" effects of the National Health Insurance, and some hospitals have begun to pivot towards developing a self-paid market to break through the limits of the healthcare global budget.

However, the issue of outpatient quotas may also lead to increased burdens on emergency departments. For example, an oncologist from a medical center in Kaohsiung shared his experience that due to a weekly outpatient limit of only 30 patients, many individuals seeking appointments are forced to turn to the emergency room. This, in turn, increases pressure on emergency services. Assuming a hospital can schedule 60 outpatient visits per day, but due to the appointment limit, 10 fewer patients can be seen, then 600 patients will not receive their normal care. If 20% of those 600 who should seek care switch to the emergency room, it will inevitably lead to a collapse of emergency services. This situation poses an imminent challenge.

Although experiences from the southern region seem to have kept hospital point values stable without significantly causing "medical crowding," a vice president of a northern medical center indicated that the situation in the southern region is somewhat special, mainly handled by two medical centers (Cheng Medical and Chi Mei) taking care of local patients, making it easier to control the number of points. In contrast, hospitals in the northern region frequently accept patients from different counties and cities and may face more difficult challenges ahead with longer appointment waiting times, prolonged examination schedules, and tight inpatient bed availability.

The new system is approaching, and the public needs to be psychologically prepared. The vice president believes that Taiwan's past medical services have been extremely convenient, but the rollout of new policies will bring substantial changes. For scheduling non-emergency surgeries, he suggests that the public arrange for medical care or procedures during the first two months of each quarter, such as January, April, July, and October, to minimize the risk of delays in surgery. While such changes can be frustrating, the policy is confirmed, and adjustments must be made in accordance with the changes.