九十年度全民健保年度醫療費用總額範圍之擬定及其政策意函

To facilitate the Bureau of National Health Insurance (BNHI) to set annual budget, control cost, enhance the financial accountability, and also to urge hospitals and clinics to participate in global budget payment system, total expenditure target (TET) for 2001 was set by the Department of Health (DOH). The purposes of this paper were to describe the methods and to discuss the implications of this policy.
The Process of setting TET began with the formulation of a reasonable range of TET by DOH and its approval by Executive Yuan, followed by the actual negotiation of TET by Health Care Expenditure Negotiation Committee (HCENC). The lower limit of TET per capital (2.21% increase) was computed by adding (1) impact of the change of population age structure on expenditures (0.80%), and (2) the medical care price index (1.41%). The latter was a composite index weighted by costing structure (%) of input factors and associated price indices proposed by Shuen-Zen Liu et al. The upper limit (4.54% increase) of TET was set based on the allowance for the above factors with some additional adjustment, including the impact of the benefits change (high tech or drug), incentive to promote quality, changing patterns of health care use, the actuarial report of the NHI, the potential saving of the intervention proposed by NHI in 2000-2001, and the economic growth rate, etc. Within the range of TET, recommended by DOH and approved by Executive Yuan, TET per capita, negotiated by HCENC, was 4.11% increase (about 340.6 billions N.T.) over and above 2000 expenditures. Among them, the annual per capita expenditure cap for dental and Chinese Medicine were 3.32% and 3% increase respectively. The per capita expenditures of the western clinics and hospital were required by HCENC to be controlled within the range of 2.21-3.97%, (4.93% if population growth was added or 6.90% if new enrollees from military sector were considered). During the fiscal year, BNHI should monitor and fix a solution (e.g. pro-ration, or setting a temporary discount on fee schedule) if the expected growth rate exceeds 3.97% orunder2.21%. To prevent from over-run, BNHI will introduce a lot of cost containment strategies. Some financial adjustment will also be proposed by DOH by the time when the reserved fund of NHI was less than one month of health care expenditures. Therefore, from 2001, hospitals will no longer be exempted from global budget. However, to be able to enhance professional autonomy, quality, and efficiency, hospitals have to participate in global budget payment system as early as possible.