The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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OHE Consulting Report for PhRMA 5 January 2011 1950 Establishment of Labour Insurance, the program aimed at the workers of government-‐run enterprises, private company employees, blue-‐collar employees, fishermen, skilled hands, drivers, and janitors of government agencies who were over 15 and under 60 years old. 1958 Establishment of Government Employees’ Insurance, which covered the employees of government agencies and holders of elected public office. 1985 Establishment of Farmers’ Insurance, which targeted members of farmer associations and individual farmers who were over 15 years old. 1995 Creation of NHI, a single-‐payer compulsory social insurance plan, which centralizes the disbursement of health-‐care funds. 1998 Establishment of CDE as a non-‐government, non-‐profit organization to support the technical evaluation of new drugs and new medical devices for regulatory requirements and offers related consultation services under the commission of DOH. 2007 Establishment of HTA as a pilot project within the CDE to provide unbiased assessment report to DBC of BNHI on cases of new drug submission for reimbursement. 2010 (January) BPA integrated into Food and Drug Administration 2010 (October) BNHI renews call for completion of “Second Generation NHI” Figure 1 Source: Lu and Hsiao (2003) 96
OHE Consulting Report for PhRMA 5 January 2011 A3.1 Overview of Taiwanese Health Care Financing, Insurance, and Delivery System Since 1995, the health care system in Taiwan is known as National Health Insurance (NHI), which is a premium-‐based, single-‐payer, mandatory, near-‐universal insurance program run by the government to allocate health-‐care funds. The system promises access to all necessary health care for citizens with national identity cards. In 2000, the coverage already amounted to over 96% of the total eligible population, and that percentage has increased each year since NHI first began. More than 80% of health providers are private organizations: this provides market competition for the delivery of health services to Taiwanese citizens. Given that reimbursement is on a fee-‐for-service basis, profit-‐maximizing clinics would have an incentive to provide some “unnecessary” (i.e., low-‐yield) services, examinations, or procedures to their patients since government is covering the bill. The Bureau of National Health Insurance (BNHI), which oversees the NHI program, has long recognized the need to prevent this type of misallocation and contain its costs. In 2002, they changed the NHI from a fee-‐for-‐service model to a global budget system. A3.2 Population, coverage, expenditure Population: 23 million people Coverage: 98% (in 2008) Total health care expenditure: 6.2% of GDP Health spending per capita: $646 (US$ PPP) [Lu and Hsiao (2003)]. A3.3 Financing The healthcare market in Taiwan is financed by a single National Health Insurance (NHI) system in which revenue flows are mobilized from either by premium payments or tax contributions together with contributions from ‘employment-‐based financing’ and from co-‐payments paid by patients. Under this scheme employers pay 60%, employees 30% and government 10%. (The NHI system is governed by the Bureau of National Health Insurance [BNHI].) Healthcare providers are paid by a fee-‐for-‐service retrospective reimbursement system, and there is a list of treatments that specifies those eligible for reimbursement (Jirawattanapisal,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, et al., 2009). See also Wu (2006). 97
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The Evolution of HTA in Emerging Markets Health-Care ... - TREE

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