讀後心得

The healthcare system will implement the "individual hospital total amount" system in the northern region in April, which will affect the allocation of medical resources and may lead to restrictions on patient treatment or increased out-of-pocket expenses. This new system requires that hospitals' annual healthcare points not exceed the previous year, and if they do, they will face the risk of reduced payments, aiming to control medical costs. Hospitals may reduce outpatient services and examinations, impacting the convenience of access to care for patients and potentially increasing the burden on emergency services. The limitations and pressures on medical resources mean that patients should be mentally prepared when seeking care and may need to adjust their healthcare plans to avoid treatment delays.

The healthcare system is about to enter an important phase of transformation! Starting in April, major hospitals in the northern region will begin implementing the "individual hospital total amount" (small total amount) system. Will this affect the allocation of medical resources, and even lead to restrictions on patient treatment or increased out-of-pocket expenses? How will the rights of the public be affected? Hospitals in the northern region (North Taipei, New Taipei, Yilan County, Kinmen County, Lienchiang County) will launch the new small total amount system this April. To control finances, hospitals will adopt various measures, such as shortening outpatient services on Saturdays and holidays, delaying examinations or non-emergency surgeries, to avoid exceeding growth rates, which could impact healthcare benefits. Although the National Health Insurance Administration emphasizes that they will establish monitoring mechanisms to ensure the public's right to medical care, based on the implementation experiences in the southern region and Kaohsiung-Pingtung area, this transformation may deprive the public of their rights to healthcare, making it more difficult to access medical services. The balance between policy and convenience remains to be observed.

So, what is the individual hospital total amount? How does it differ from past systems? The previous total amount system of the National Health Insurance solely focused on the quantity aspect, leading to competition among hospitals striving for "volume," resulting in issues of over-medicalization. Since the implementation of this system 22 years ago, the budget gap has continuously widened, leading to drug shortages and lagging behind other countries in the introduction of new drugs and technologies. To address these issues, the National Health Insurance Administration began implementing the "Individual Hospital upfront budget management pilot program" in the southern region, requiring each hospital not to exceed the previous year's healthcare points within the fiscal year; excess points would be discounted or even not reimbursed, which is referred to as "cut-off." Simply put, it means limited resources, and additional medical behaviors will not receive extra compensation.

The northern region hospitals are the last among the six major regions in the country to implement the "small total amount" system. Although the head of the National Health Insurance Administration assures that emergency and rare diseases will not be included in the hospital's budget, experts from the healthcare management society point out that the hospital's strategies may affect the public's right to healthcare. While the new system allows hospitals to manage resources more effectively, any system has its pros and cons. Experts say the small total amount system may lead hospitals to start "tightening their budgets," such as reducing the number of registrations, adjusting examination schedules, and delaying non-emergency surgeries, which could affect the public's accustomed fast medical service model.

The introduction of the new system means that the public must understand the multiple impacts. Taking the existing small total amount system as an example, an anonymous hospital director pointed out that while the National Health Insurance Administration calculates quarterly, in practice, departments still operate normally in the first two months, only to find out about exceeding limits at the end of the quarter. At that point, they will take restrictive measures, commonly limiting the number of outpatient visits and reducing unnecessary medications and examinations. In summary, whether one can receive care will depend on the hospital's ability to regulate. Different hospitals may have varying control methods, with some even changing medications or postponing surgeries due to cost issues.

For instance, regarding cataract surgery, the waiting time used to be about two weeks, but under the new system, it may be extended to three months or even longer. Imaging examinations will similarly be affected, with patients often needing to wait more than two months to complete their examinations. This delay not only causes long wait times but may also impact the timely diagnosis and treatment of conditions.

Some hospital officials have pointed out that the small total amount system has been in operation in the Kaohsiung-Pingtung area for two years and has resulted in some changes; hospitals, facing pressure from healthcare subsidies, have had to absorb costs themselves. Some hospitals have begun to focus on the out-of-pocket market in hopes of finding new paths forward.

Regarding the potential increase in pressure on emergency services due to limitations on outpatient numbers, a physician from Kaohsiung Medical Center shared his experience. Due to restrictions on outpatient registration, there are weekly patients who cannot receive their desired medical care, forcing them to turn to emergency departments, exacerbating the situation in emergencies.

Although the implementation experience in the southern region has led to stable point values, experts candidly state that northern region hospitals, which need to accommodate diverse patients, will still face numerous challenges in the future, such as more difficulty in registering, longer waiting times for examinations, and tight inpatient bed availability.

In the face of these changes, the public needs to be mentally prepared. Experts recommend that for arrangements of non-emergency surgeries, the public should seek medical care or surgery in the first two months of each quarter to avoid delays. While these measures may not be satisfactory, the only option after the policy is set is to adapt to the changes.