TAIPEI (Taiwan News) — The National Health Insurance Administration is preparing to revise a key regulation that governs how medical institutions contract with the National Health Insurance system, marking its first update in 12 years.
The current “Regulations Governing Contracting and Management of National Health Insurance Medical Care Institutions” outlines the procedures that enable medical providers to join the NHI network and accept patients using NHI cards. NHIA official Liu Lin-yi (劉林義) noted that although related healthcare laws have undergone several amendments, this core regulation has remained unchanged.
Five major areas have been identified for amendment. The agency aims to finalize the changes by year’s end, per CNA.
One key update will allow partial contract termination for medical institutions, which is currently only available to hospitals. It will also expand eligibility for contracting to include specialized facilities such as audiology centers.
To address concerns over rigid penalties, the NHIA plans to ease rules that bar institutions from contracting for five years if their contracts were suspended twice at the same location. This provision will be adjusted to align with broader healthcare laws, where the most severe penalties typically last only one year.
Additionally, support obligations will be expanded to include long-term care service providers. In Taiwan’s NHI system, this mechanism primarily refers to mutual physician manpower support between institutions, enabling doctors from one facility to assist another facing staffing shortages.
Another focus is promoting information transparency between medical providers and the public. Institutions will be required to identify services that cannot be charged as out-of-pocket expenses and ensure that non-NHI services are properly explained and documented.
A new contracting model is being introduced to raise standards in areas with abundant healthcare providers. Contracting will prioritize higher-performing institutions and may evaluate clinics with billing levels comparable to small hospitals under stricter criteria.
New hospitals will be assessed based on regional needs and bed capacity and may receive contracts on an annual basis. The updated approach aims to raise the overall quality of contracted providers.
The final key area involves aligning the regulation’s authorization clauses with existing laws to eliminate redundancy. For instance, revisions to Article 26 will enable hospitals to legally reduce or end insurance coverage when a patient refuses discharge despite being medically stable.
Hospitals will be allowed to classify prolonged stays as out-of-pocket or partial out-of-pocket care, easing the strain on inpatient resources. Previously, providers were required to specify detailed discharge assistance measures.
A preliminary meeting held Thursday with stakeholders, including medical professionals, NHI committee members, and consumer representatives, found general agreement on most of the proposed changes. However, the contracting model drew more debate, and suggestions were made to clarify hospital responsibilities around discharge planning.
A second round of discussions is scheduled for May 8 with officials from the Ministry of Health and Welfare and healthcare organizations. If the process proceeds as planned, a 60-day public consultation period will follow, to implement the revisions before the end of the year.
