A trial capitation payment system for Taiwan’s national health insurance will get under way in July in an attempt to curb the waste of medical resources, the Department of Health said May 17.
Eight selected hospitals and their subsidiary clinics will participate in a three-year pilot program that seeks to avoid excessive diagnosis and treatment, thereby providing higher quality medical services, according to the Bureau of National Health Insurance.
“Under a capitation system, health care service providers are paid a set amount for each potential patient assigned to the hospital based on community population size,” said Tsai Shu-ling, a division director at the bureau. For example, all the people residing in Kinmen County are considered enrolled patients at the DOH’s Kinmen Hospital, Tsai explained.
“Loyal patients” who make more than half of their visits to the same hospital are also counted, she added.
This means NHI payments to the hospital are based on the average patient’s expected health care utilization, regardless of the number or nature of services actually provided, Tsai said.
“The system is expected to cut down on medical costs compared to the current fee-for-service reimbursement, where there is a tendency to overprescribe, overdiagnose and overtreat as it pays physicians according to the number of patients treated,” she said.
“Health service providers who work under a capitation plan will be encouraged to focus on preventive health care as they will receive greater financial rewards for keeping people healthy than for treating them when they become sick,” Tsai added.
The program will be reviewed periodically by a panel of experts during its trial run, she said.
