pLOG

2024-09-02

Smart Patient Leader Academy Invites Government, Academia, and Industry to Discuss Collaboration Between National Health Insurance and Commercial Insurance to Improve Access to New Medications

With breakthroughs in medical technology, various new treatments, precision medicine, and medical devices are emerging, providing people with more options but also presenting significant financial burdens. Tsai Hung Integrated Marketing has long supported the Smart Patient Leader Academy, which is dedicated to cultivating patient leaders, by providing services such as corporate volunteerism, strategic consulting, and resource matching. Under this support, the Smart Patient Leader Academy held a discussion on August 7th titled "The Feasibility of Coordinating National Health Insurance and Commercial Insurance." The event invited experts from various fields to share insights on the current state of Taiwan's National Health Insurance and commercial insurance systems and to analyze existing policies in other countries as references for future policy development.

Collaboration Between Government, Academia, and Industry on Coordinating National Health Insurance with Commercial Insurance: Matching Resources with Institutions to Design Insurance Products

In recent years, the National Health Insurance Administration (NHIA) and numerous scholars have begun discussions on the possibility of coordinating national health insurance with commercial insurance. The goal is to use government-defined coverage areas while allowing insurance companies to develop new insurance policies that supplement national health insurance. At the same time, insurance companies can leverage data from the national health insurance platform to understand the prevalence of various diseases, which helps in predicting the effectiveness of new treatments and in designing market-appropriate products.

Zhang Wenwen, the head of the underwriting department at the NHIA, added that Taiwan's NHIA has already started to collaborate with some hospitals to provide data to insurance companies, which aids in the actuarial calculation of insurance premiums.

Professor Lu Ruifen from the Institute of Management and Department of Health Care Management at Chang Gung University pointed out that this collaborative approach is already in practice in other countries. For instance, Canada has introduced complementary commercial health insurance to cover costs associated with private hospital care, outpatient medication, and dental services. Meanwhile, Taiwan’s National Health Research Institutes is conducting a project titled "Enhancing Medical Security: Exploring the Feasibility of Coordinating National Health Insurance with Commercial Insurance" (of which Professor Lu is a co-convener). This project is currently developing feasible plans, with a report expected to be released early next year.

You Naiying, the Deputy General Manager of the Product Department at Nan Shan Life Insurance, added that, specifically regarding cancer—a high-interest area—there is a recent trend towards cancer treatment supplements, which cover high-cost and innovative treatments such as robotic surgeries, post-cancer genetic testing, and targeted therapies. Discussing the feasibility of future implementation, Professor Huang Xiuling, the founder of Modern Insurance Magazine and the Modern Insurance Education Foundation, stated frankly, "Commercial insurance cannot seamlessly integrate with national health insurance." Before the formal release of various policies, she suggested that, for now, supplementary insurance products, lump-sum insurance, or home care insurance could serve as interim solutions.

Experts Advocate for a "Second-Layer Health Insurance" Concept with Different Deductibles to Promote Individual Responsibility

In addition to the currently feasible approaches, Professor Huang Xiuling also introduced the concept of "second-layer health insurance." This concept draws inspiration from the mandatory automobile liability insurance that was introduced in 1998, which is characterized by universal coverage, no-fault claims, and prompt payments. She suggests applying the concept of mandatory auto insurance to the existing National Health Insurance (NHI) system by layering an additional supplemental health insurance plan on top of it. This second-layer health insurance could incorporate various deductible levels, allowing individuals to choose different levels of out-of-pocket expenses based on their financial capabilities, thereby fostering a spirit of shared responsibility.

Zhang Xiangxin, Managing Director of Tsai Hong Health Integration Group, also shared his perspective: "The public's demand for healthcare is increasing every year, and the policy of commercial insurance supplementing national health insurance is inevitable. How to implement it and how to maximize its benefits will be the focus of ongoing discussions in the future. The Smart Patient Leadership Academy, the Taiwan Cancer Society, Tsai Hong, and other organizations will continue to pay close attention to this issue."

Zhang Wenwen, the head of the underwriting department, concluded by stating that next year, the government will allocate funds for a "temporary payment fund for new cancer drugs." During the rollout of this new policy, government, industry, and academia will continue to delve deeply into how resources from various sectors can be coordinated, how platforms can be integrated, and whether patients with chronic and debilitating conditions can be included in the coverage. The ultimate goal is to ensure that every citizen in Taiwan can access the best medical resources available.

─ PatientsForce PR & Marketing Manager, Amber Chang