Government suspends plan to cap out-of-pocket medical device expenses

Health Minister Chen Shih-chung (left) and NHIA Director General Lee Po Chang speak to the press after the June 13 meeting on the issue. (Photo courtesy of CNA)

TAIPEI (CNA) — The government has suspended a plan to cap the amounts patients pay out-of-pocket for certain special medical devices after facing strong opposition from the medical sector.

Health Minister Chen Shih-chung (陳時中) announced the suspension of the new policy that was scheduled to begin on Aug. 1 in the wake of his meeting Saturday with representatives of the sector on the controversial plan.

On June 8, the National Health Insurance Administration (NHIA) under the Ministry of Health and Welfare published a list of its approved maximum out-of-pocket expenses patients could pay for 352 items in eight medical device categories, ranging from intraocular lenses to drug-eluting coronary artery stents.

The NHIA said that day that starting Aug. 1, NHI-contracted hospitals and clinics would be banned from charging amounts higher than the published ceilings, sparking a backlash from the health care sector.

Under Taiwan’s national health insurance system, the NHIA does not reimburse hospitals for the full cost of some more advanced or expensive devices within the eight categories.

For those devices, the NHIA generally covers an amount up to the cost of a basic device, and hospitals charge patients an additional amount to cover the balance of the device’s expense.

For example, if a patient needs an expensive intraocular lens with special functions, the NHIA would reimburse the amount for a standard lens, with the hospital left to bill a patient for the balance.

Representatives from a doctors’ union attend the June 13 meeting. (Photo courtesy of CNA)

The government said its policy was aimed at preventing huge differences in the out-of-pocket payments charged patients by different hospitals and clinics in efforts to protect the rights of consumers.

Many physicians and medical experts around Taiwan rebelled, however, arguing that setting such ceilings would stop medical device businesses from introducing premium products due to cost limitations.

Critics also said the new policy ignores the differences in medical quality, techniques and equipment used at different hospitals and clinics, and would mainly benefit private insurance companies by saving them from high reimbursements.

After Saturday’s meeting, Chen reversed course, saying the ceilings on out-of-pocket expenses were not absolutely necessary.

He said the NHIA will focus on efforts to regulate the prices of medical devices that have monopoly status in the market.