Contents
Where are we in IT –
Taiwan's National Health
Insurance
• A brief introduction to Taiwan’s
National Health Insurance
• Information Technology in NHI
• Key features for Taiwan’s e-health
HongHong-jen Chang, MD, MPH, MS
CEO and President
Bureau of National Health Insurance
Taiwan, June 7, 2004
• Conclusion
Bureau of National Health Insurance
www.nhi.gov.tw
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Health Indices
(2002)
China
Japan
USA
Profile of Taiwan(2002)
Population: 22.52 million
Land area: 36,188 km2
(14,000 mile²)
Population density: 622 per
km2
Population aged over 65 :
9.02%
GNP per capita : US
$12,900
NHE as % of GDP: 5.99%
Q
Q
Q
Q
Q
Q
Crude Birth Rate: 11.02 0/00
Crude Death Rate: 5.73 0/00
Natural Increase Rate: 5.29 0/00
Infant Mortality Rate: 5.35 0/00
Maternal Mortality Rate: 7.68 0/0000
Life Expectancy: 73.03 Male
78.82 Female
Map of Taiwan, ROC
Bureau of National Health Insurance
www.nhi.gov.tw
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(8.06%)
1985 Farmer Insurance (8.21%)
1995 National Health Insurance
4
ƒ Dominated by the private sector
ƒ Closed-staff system for hospitals
ƒ Patients are able to choose care providers
freely
ƒ No gate-keeper system
ƒ Hospitals accredited by DOH every 3 years
ƒ High service volumes in outpatient
department in most hospitals
1950 Labor Insurance (40.12%)
1990 Low
- income Household Insurance
www.nhi.gov.tw
Characteristics of
the Healthcare System
Milestones in Social Insurance
1958 Government Employee Insurance
Bureau of National Health Insurance
(0.55%)
(99%)
*( ) indicates % of covered population
Bureau of National Health Insurance
www.nhi.gov.tw
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Bureau of National Health Insurance
www.nhi.gov.tw
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1
Characteristics of NHI (1)
Characteristics of NHI (2)
ƒ Cost sharing for ambulatory care,
inpatient care, and drugs
ƒ Mandatory enrollment
ƒ Single
- payer system
ƒ Public Administration
ƒ Payroll- related premium rate
ƒ Comprehensive benefit package
ƒ Fee-for-services under the Global
budget
ƒ Contribution shared by the employer, the
employee and the government
Bureau of National Health Insurance
Health Care Expenditures per Capita,
Adjusted for Cost-of-Living Differences
US Dollars
5,000
7
www.nhi.gov.tw
Bureau of National Health Insurance
8
www.nhi.gov.tw
National Health Expenditures as % in GDP
1983
- 2002
4,631
4,500
% of GDP
6.0
4,000
3,500
NHI
5.97 5.99
5.5
5.0
4.5
4.0
1,623
3.5
1,207
893
3.70
4.00 4.10 4.00
3.90
Japan
United
Finland
New
Korea
Taiwan
Median
[2000]
Kingdom
[2000]
Zealand
[2000]
[2000]
Government Sector
0.5
[2000]
0.81
1.89
1.85
1.82 1.77 1.82
1.8 1.85
0.82
0.81
0.77
0.69
0.59
0.51
0.47
0.47
0.46
0.51
0.45
9
www.nhi.gov.tw
1986
1985
1983
0.0
Information resource :
1. OECD Health Data,2000~2002
2. International Health Policy之Chart VIII-1 from Multinational Comparisons of Health System Data,2000
Bureau of National Health Insurance
1.65
1.96 2.02
1.0
1984
[2000]
Health Insurance
1.5
2.00
2002
OECD
[2000]
2.1
2.16
2001
Australia
[2000]
2.18
1999
France
[2000]
3.44
3.02
2000
Canada
[2000]
3.14
1997
Germany
States
2.21 2.1
Private Sector
2.0
United
3.06
2.76
2.5
0
[2000]
3.24
2.94
2.93
3.0
500
[2000]
4.93
4.77 4.81
4.20
1998
1,000
4.00
1995
1,500
4.67
3.80
1996
1,664
1993
1,763
Bureau of National Health Insurance
1994
2,012
1992
2,022
1990
2,211
2,000
1991
2,349
2,500
5.46 5.44
5.27 5.29 5.27 5.33
Total Health Expenditures
1988
2,535
1989
3,000
1987
2,748
www.nhi.gov.tw
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Information Technology in
NHI
High Public Satisfaction
(1995～2004)
90.0%
78.50%
80.0%
70.0%
66.5%
65.4%
60.0%
40.0%
67.2%
63.8%
63.3%
61.0%
50.0% 47.0%
76.30%
70.90%
66.40%
71.1%
68.3%
59.70%
65.6%
Satisfied (DOH)
Satisfied (BNHI)
50.2%
Dissatisfied (DOH)
Dissatisfied (BNHI)
36.5%
39.0%
27.0%
30.0%
20.0%
25.9%
23.4%
22.5%
10.0%
29.60%
24.5%
24.2%
22.0%
Satisfied
20.1%
17.2%
13.60%
Dissatisfied
20.60%
21.60%
15.90%
0.0%
1995/5
1995/9
1996/6
1998/1
1998/4
1998/11
1999/5
2000/3
Bureau of National Health Insurance
2000/10
2001/6
2001/12
2002/5 2002/8 2002/11 2003/7
www.nhi.gov.tw
2004/4
11
Bureau of National Health Insurance
www.nhi.gov.tw
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2
IT/Information Management for
Efficiency
Electronic Medical Claims
The Rate of Claims through Electronic Media
• Electronic claim processing system
100%
– Uniform reporting procedure and format
– Standardize coding system
90%
80%
• Comprehensive databank
• Data Warehouse for Decision support
• Profile analysis system for utilization
review and management
• Web site provide information sharing with
providers
70%
60%
50%
Out-patient
In-patient
40%
30%
20%
10%
0%
May. Sep. Jan. May Sep. Jan. May Sep. Jan. May Sep. Jan. May Sep. Jan. May Sep. Jan. May Sep.
1995
1996
1997
1998
1999
2000
2001
Bureau of National Health Insurance
www.nhi.gov.tw
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NHI Smart Card
•
•
•
•
www.nhi.gov.tw
Explicit Data
IC Chip
Basic Data Section
Healthcare Data Section
Medical Data Section
Health Administration Data Sec.
15
Bureau of National Health Insurance
Name
ID Number
Birth date
Photograph (Optional)
www.nhi.gov.tw
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Future Phase-In Plans
• Daily monitor of
utilization
• Instant checkup of
patient’s eligibility
• Daily monitor of
communicable disease
Bureau of National Health Insurance
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NHI smart card
Change of Management
• Monthly monitor of
medical expenditure
• Eligibility checkup
while renew paper
card
• Periodically data
exchange with CDC
www.nhi.gov.tw
Content of Smart Card
A new milestone for NHI
Pilot on Pescadores in May 1995.
Formally implemented in January 2004
Provide timely information on “where and
when” patient received healthcare
services
Bureau of National Health Insurance
Bureau of National Health Insurance
• Organ donation
• Weekly monitor of hospital
expenditure
ÆSARS
ÆInbound traveler or
immigrant
www.nhi.gov.tw
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Bureau of National Health Insurance
www.nhi.gov.tw
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3
Key Features for Taiwan’s
e-Health
Bureau of National Health Insurance
www.nhi.gov.tw
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Taiwan’
Taiwan’s ee-Health (1)
– Medical claims integrate with other data base
to provide population
- based information
– Valuable databank for researchers,
healthcare providers and policy- makers
• System is designed to maximize benefit from IT
– Unique identity card for every resident in Taiwan
– BNHI set up various common standards for IT
implementation
– NHI smart card project provide network linkage
environment
• Privacy protection and security challenges
– Patient groups – AIDS
– Human right groups
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Planning of NHII Project
www.nhi.gov.tw
Bureau of National Health Insurance
www.nhi.gov.tw
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Objectives of NHII Project
• Establish an interoperable & integrated
health information platform.
• Set up an information framework to
support continuous healthcare services.
• Initiating national health information
strategic plan to establish national health
information infrastructure (NHII).
• Invest from public sectors USD 670
million in the next 5 years.
• Joint venture of public, private sectors,
academics and industries.
Bureau of National Health Insurance
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• Integrated databank
– Mobile phone subscribing rate 106.5% (ITU 2003)
– Internet subscribing rate 38%
– Digital Access Index No.9 in the world
www.nhi.gov.tw
www.nhi.gov.tw
Taiwan’
Taiwan’s ee-Health (2)
• People enjoy information technology
Bureau of National Health Insurance
Bureau of National Health Insurance
– Acute care
– Chronic care
– Health promotion
• Comprehensive national healthcare
databanks to support R&D
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Bureau of National Health Insurance
www.nhi.gov.tw
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4
Proposed Strategic Areas of NHII
• Healthcare Information Technology
Conclusions
– NHI Smart card
• Personal Health informatics
– Electronic Health Record(EHR)
• Public Health and Medical informatics
– Clinical decision support and patient
safety system
– Disease Surveillance
• Ethical, Legal and Social Implications
Bureau of National Health Insurance
www.nhi.gov.tw
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Taiwan’s NHI system:
•
•
•
•
www.nhi.gov.tw
www.nhi.gov.tw
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Possible factors contributing to
the success of Taiwan’
Taiwan’s NHI
• Single-payer system
• Free market on delivery side
Affordable
Accessible to all
High public satisfaction
Quality of care Acceptable
Bureau of National Health Insurance
Bureau of National Health Insurance
• IT intensive operating system
• Strong generic pharmaceutical industry
• Physicians willing to work very hard at
relatively low physician fee
• Tradition of family support
• Good doctor-patient relationship
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Bureau of National Health Insurance
www.nhi.gov.tw
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Thank you !
Bureau of National Health Insurance
www.nhi.gov.tw
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