Payment Structure

Abstract

The payment system has a great impact on the overall growth of medical expenses, the distribution of medical resources as well as medical efficiency and quality. To quickly integrate the existing civil service, labor, and farmers’ insurance system, the fee-for-service approach was adopted as the primary National Health Insurance (NHI) payment system at the beginning of its establishment. The content also elaborates the concept and operation mechanism of the global budget payment system and various supplemental payment methods in the NHI, such as case payment, per diem payment, pay-for-performance and Taiwan diagnosis-related groups (Tw-DRGs). The challenge of securing relative value units (RVUs) or RVU value to foster specific healthcare services is discussed in this chapter. The National Health Insurance Administration (NHIA) continues to revise the fee schedule to reflect technological progress, real clinical needs and reasonable rewards for health professionals. In this chapter, we introduce the process for the revision of the fee schedule and the integration of Health Technology Assessment (HTA) in decision-making. To close the inevitable budget gap, self-management of the global budget for each NHI district and payment department was designed to contain medical costs.