Digital Health Care in Taiwan : Innovations of National Health Insurance / Po-Chang Lee, Joyce Tsung-Hsi Wang, Tzu-Yu Chen, Chia-Hui Peng, editors.

Format:

Book

Author/Creator:

Lee, Po-Chang., Editor.

Contributor:

Lee, Po-Chang, editor.

Wang, Joyce Tsung-Hsi, editor.

Chen, Tzu-Yu, editor.

Peng, Chia-hui, editor.

Language:

English

Physical Description:

1 online resource (286 pages)

xxiv, 270 pages : illustrations ; 24 cm

Edition:

1st ed.

Place of Publication:

Cham Springer Nature 2022

Cham : Springer International Publishing AG, 2022.

Language Note:

English

Summary:

This open access book introduces the National Health Insurance (NHI) system of Taiwan with a particular emphasis on its application of digital technology to improve healthcare access and quality. The authors explicate how Taiwan integrates its strong Information and Communications Technology (ICT) industry with 5G to construct an information system that facilitates medical information exchange, collects data for planning and research, refines medical claims review procedures and even assists in fighting COVID-19. Taiwan's NHI, launched in 1995, is a single-payer system funded primarily through payroll-based premiums. It covers all citizens and foreign residents with the same comprehensive benefits without the long waiting times seen in other single-payer systems. Though premium rate adjustment and various reforms were carried out in 2010, the NHI finds itself at a crossroads over its financial stability. With the advancement of technologies and an aging population, it faces challenges of expanding coverage to newly developed treatments and diagnosis methods and applying the latest innovations to deliver telemedicine and more patient-centered services. The NHI, like the national health systems of other countries, also needs to address the privacy concerns of the personal health data it collects and the issues regarding opening this data for research or commercial use. In this book, the 12 chapters cover the history, characteristics, current status, innovations and future reform plans of the NHI in the digital era. Topics explored include: Income Strategy Payment Structure Pursuing Health Equity Infrastructure of the Medical Information System Innovative Applications of the Medical Information Applications of Big Data and Artificial Intelligence Digital Health Care in Taiwan is essential reading for academic researchers and students in healthcare administration, health policy, health systems research, and health services delivery, as well as policymakers and public officials in relevant government departments. It also would appeal to academics, practitioners, and other professionals in public health, health sciences, social welfare, and health and biotechnology law.

Contents:

Intro

Foreword

Investing in the National Health Insurance Is Investing in Health

Preface

Thoughts on Reforming the National Health Insurance

Acknowledgments

Contents

About the Contributors

About the Editors

Abbreviations

Chapter 1: Introduction to the National Health Insurance of Taiwan

The Core Concepts of Taiwan's National Health Insurance

The Organisational Structure and History of the National Health Insurance Administration

Characteristics of Taiwan's National Health Insurance

The Finance of the National Health Insurance in Taiwan

Medical Utilisation of the National Health Insurance

The Payment System of the National Health Insurance

The Healthcare Quality of the National Health Insurance

The Information System of the National Health Insurance

Achievement of the National Health Insurance

The Critical Blueprints of Taiwan's National Health Insurance

Chapter 2: Income Strategy

Introduction

Sources of National Health Insurance Income

Premium Income

Proportions of Various Sources of Income

Enrolment Eligibility and Premium Calculations

Classification of the Insured

Calculation of Premiums

Calculation of the Premium Rate

The Annual Premium Rate Review Process

The Financial Structure of National Health Insurance

Establishment of an Actuarial Model to Calculate the Premium Rate

Co-payments Under the National Health Insurance Act and How They Are Charged

Co-payments for Outpatient Visits

Co-payments for Emergency Care

Co-payment Rates for Inpatient Care

Fair Burden─Change Unnecessary Health Care [1]

The Value of National Health Insurance Manifests When Major Illnesses Occur

Provide the Best Drugs for Patients in Need

Avoid the Vicious Circle

Drug Co-payments May Increase Slightly

Conclusion

Reference.

Chapter 3: Payment Structure

Different Payment Methods in the National Health Insurance System

A Simple Explanation of the Global Budget Payment System

Introduction to Each Payment Method

Implementation of Pay-for-Performance and Bundled Payment in Recent Years

Global Budget Payment System

Planning the Annual Global Budget

Global Budget Distribution and Management

Reducing the Provision of Unnecessary and Excessive Medical Services to Increase the Value of the Relative Value Unit

Relative Value Units and Relative Value Unit Values are the Overall Causes and Outcomes of Each Other

Adjusting Relative Value Units to Promote Balanced Development of Medical Specialties

Guaranteeing the Relative Value Unit Value to Encourage Investment in the Healthcare Workforce

Establishment and Revision of Fee Schedule

Fee Schedule Revision Procedure

Health Technology Assessment

Items Not Been Covered by the NHI

Self-Management Plan Under the Global Budget Payment System and Corresponding Measures of Insufficient Budgeting

Self-Management Plan

Subtracting Relative Value Units Directly

Sharing the Relative Value Unit Gap

Analysis and Reflections

Chapter 4: Comprehensive Policies

Implementation of the Separation of Medicine and Pharmacy from a National Health Insurance Perspective

The Meaning of Separating Medicine and Pharmacy

The Effectiveness of Separating Medicine and Pharmacy

Ownership of Dispensing Rights from a Legal Perspective

The Person in Charge of Medical Services in the National Health Insurance System

The Strategy to Promote Separation of Medicine and Pharmacy-Discussion and Conclusions

Patient-Centered Integrated Care Plans

National Health Insurance Big Data Reflect the Ageing Population

The Family Doctor Integrated Care Program.

Providing a New Model of Integration and Interdisciplinary Services

Incorporating the Labor Power of Home Care into Integrated Care

Promoting the Vertical Integration of Hospitals and Clinics

Healthcare Digital Transformation Brings Win-Win-Win for Physicians, Patients, and National Health Insurance

Connection to Long-Term Care After Hospital Discharge

Covering the Discharge Planning and Follow-Up Management Fee Through National Health Insurance

Implementation of Long-Term Care 2.0

Connection Between National Health Insurance Discharge Planning and Long-Term Care 2.0

Tiered Medical Care System

Current Distribution of Hospital Levels

Encouraging Big Hospitals to Treat Acute, Severe, and Difficult Diseases

Small Hospitals Are the Leaders of Community Medical Care

Consolidate Small Hospitals in Remote Areas to Continuously Protect the Health of Residents

Co-Payment Adjustment

Current Situation Analysis

The Planning, Thinking, and Direction of Outpatient Co-Payments

References

Chapter 5: Pursuing Health Equity

Removing Barriers to Health Care to Protect the Disadvantaged

Decoupling of the Payment of Premiums from the Right to Receive Medical Care

The National Health Insurance Premium Deferment Paying Measures of the COVID-19 Epidemic

Medical Services on Remote and Offshore Islands

The Integrated Delivery System

Improvement Plan for Medically Underserved Areas

Upgrading Medical Services in Underserved Areas

National Health Insurance Strives to Remove Barriers to Medical Treatment

Prospects

National Health Insurance Stands by Patients with Rare Diseases

Rare Diseases Are Categorized as Catastrophic Illnesses to Waive Patient Co-Payments

Strengthening Control Measures for Orphan Drugs

My Health Bank-Promoting Self-Health Management.

My Health Bank Guards Our Health

Rapid Cell Phone-Based Certification Allows Users to Manage Their Medical Information Easily

Family Member Management Function Added to Safeguard Family Health

Software Development Kit Connects Health Services Better

Supporting Name-Based Mask Distribution System to Assist the Country in Epidemic Prevention

The Significance of Including National Health Insurance in Elementary School Teaching Materials

Chapter 6: Infrastructure of the Medical Information System

Cornerstone of the National Health Insurance Database-Introduction to the NHI Medical Information System

Highly Automated Process of Medical Claims

Establishing National Health Insurance MediCloud System to Implement a Tiered Medical Care System

The National Health Insurance MediCloud System

Building Patient-Centered "NHI PharmaCloud System"

Upgrading of the "NHI MediCloud System"

Design of Active Reminders in the NHI MediCloud System

Personal Privacy Protection and Information Security Management

Cloud-Based Healthcare Technology Is a Future Trend

Continuously Upgrading the NHI MediCloud System

Applying the Technology to Provide Reminders Proactively

Image Upload, Retrieval, and Sharing

Importing ISO Certification to Protect Personal Information

Integrating Information Across Organizations to Safeguard the Health of All Residents

Continuous NHI MediCloud System Upgrade Enables Smart Medical Care

The National Health Insurance Information Security Management System and Data Protection Mechanism

Continuous Improvement of the Information Security Management Mechanism

Defense-in-Depth Mechanism Implementation and Internal and External Network Isolation Policies

Regular Information Security Testing and Drills to Reduce the Potential Risks of Information Security.

Implement Database ID Entity Encryption Mechanism

Chapter 7: Innovative Applications of the Medical Information

The Important Milestone: "2021-First Year of Telemedicine Being Covered"

The COVID-19 Pandemic Accelerates the Inclusion of Telemedicine into the Benefits Package of the National Health Insurance

Inclusion of Telemedicine in the Fee Schedule in 2021

Digital Technology Extends Medical Care

The Major Stride of Health Insurance Information Network and Far-Reaching Medical Services Made Possible by 5G

Brief Talk About the Health Insurance Information Network

Enter the 5G Era

Future Direction

Virtual NHI Card Users in the 5G Era

Planning for a New Generation NHI Card

The Virtual NHI Card Pilot Program

Continuous Function Progresses

Using the National Health Insurance Information System for COVID-19 Prevention

The Cross-Departmental Cooperation of the National Health Insurance Cloud System to Add a TOCC Reminder

Establish a Control System for Masks and Distribute Protective Materials Fairly

Enhance NHI Express APP and My Health Bank Functions for COVID-19 Prevention [1]

The Name-Based Medical Mask Distribution System Is a Successful Model Established by Government and Private Sector Partnerships to Fight the COVID-19 Pandemic [2]

Medical Masks Become Popular Anti-epidemic Materials

Government and Private Sectors Cooperate to Create the Mask Map

The Coverage Rate of Name-Based Medical Mask Distribution System Is Improving Continuously

The Resilience of the NHIA Organization Is a Blessing For All

Chapter 8: Drug and Medical Device Reimbursement

How Are Drug Prices Determined?

Classification and Pricing of the Drugs Under the National Health Insurance

Adjustment of Drug Price.

How to Classify Medical Devices and Determine the Price?.

ISBN:

3-031-05160-2

OCLC:

1341850419