Lai suggests different pay scales to address doctor shortage

Taipei, March 29 (CNA) President Lai Ching-te (賴清德) on Saturday called for structural reforms to the National Health Insurance (NHI) system, including the adoption of a "different pay for different work" model, to address an ongoing shortage of physicians in Taiwan.

"Does the NHI have problems right now? Yes, it does. One issue is the sustainability of its finances, with the other being the difficulty in recruiting medical professionals," Lai said at an event marking the 30th anniversary of the NHI's introduction in Taiwan.

"It's not just nurses we're having trouble recruiting -- the same goes for doctors," Lai said.

He said the current fee-for-service model, in which doctors are paid based on the number of services performed, should be reviewed, and suggested that a "different pay for different work" model be adopted as part of structural reforms to the NHI system.

"If doctors are doing different kinds of work but receiving the same pay, then of course, fewer doctors will choose the more demanding specialties," Lai argued, referring to specialties such as internal medicine, surgery, obstetrics and gynecology, and pediatrics.

It was not exactly clear what new structure Lai was proposing, and he did not provide any details.

At present, the National Health Insurance Administration (NHIA) sets a schedule annually for what the amount it reimburses for different services.

There is a mechanism that allows for revisions to be made to address imbalances if payments for certain services are too low, and NHIA Director-general Shih Chung-liang (石崇良) said after the event that the reimbursement system could be adjusted.

He said the agency is thinking of dividing outpatient consultations into two types -- general and complex -- that would earn different reimbursement rates for doctors.

Given that surgical procedures vary in time and complexity depending on the specialty, some departments already receive different levels of payment based on a resource-based relative value scale (RBRVS), a system used to determine appropriate compensation for medical providers, according to Shih.

However, payments for services in some specialties may not have been fully adjusted, he admitted, and said they will be reviewed gradually in the near future.

Meanwhile, Shih said that starting May 1, the drug vosoritide will be covered by the NHI for young patients with achondroplasia, a rare genetic disorder that affects bone growth and typically results in short stature of around 130 centimeters.

He added that while the drug, currently the only treatment for achondroplasia, costs around NT$7 million (US$210,839) per person annually, it enables patients to live normal lives and contribute to society.

According to Shih, 72 young patients with achondroplasia across Taiwan will benefit from the new NHI coverage.