NHI co-pay for nonreferral appointments likely to rise in 2026: Official

Taipei, Oct. 28 (CNA) The National Health Insurance (NHI) outpatient co-payment for patients visiting large hospitals for minor health issues without a referral could increase significantly later next year, an official said on Tuesday.

NHI official Liu Lin-i (劉林義) said that a proposal to raise the nonreferred co-payment at medical centers to NT$1,200 (US$39.19), from the current level of NT$420, is regarded as a "last resort" to reserve larger medical centers for critical and complex cases.

The proposed hike would amount to half of the average NHI reimbursement for a medical center outpatient visit, which is about NT$2,400, according to Liu, chief of the Medical Affairs Division of the National Health Insurance Administration.

Liu said that an assessment on whether to increase the co-payment would be conducted in July, but only if a review determines the "reimbursement cap" measure fails to ease outpatient visits at medical centers in the first half of next year.

Introduced incrementally by region this year, the measure caps NHI reimbursement for outpatient services, aiming to limit resources hospitals dedicate to minor health issues and to reinforce the tiered healthcare system, according to the NHI.

Under this measure, a medical center's NHI reimbursement for outpatient services is capped at 55 percent of the institution's total revenue, Liu said.

Liu said the NHI hopes to further lower this percentage, pending negotiations with the medical community, and added that the agency will allow a six-month trial period to assess whether the measure produces the desired results.

Liu made the remarks to elaborate on ideas unveiled by Health and Welfare Minister Shih Chung-liang (石崇良) in an interview with United Daily News published Tuesday.