National Health Account in Taiwan:National Health Account in Taiwan:An updateAn update

Chung-Fu LanNational Yang-Ming University

Pi - Joen Lee Department of Health, ROC (Taiwan)

Seoul, 5th SHA Meeting June 16, 2009

Financial Flows in Taiwan’s Health Care System

Health Financing Overview, Taiwan 2005

Population (million) 23Gross domestic products (GDP) per capita US$ 15,7

14

Total Expenditure on Health (TEH) per capita US$ 957Public US$ 562

general gov’t (excl. social security) US$ 52social security fund US$ 511

Private US$ 395

General government spending on health as a share of total government spending 11.50%

Pharmaceuticals as a share of TEH 26.50%TEH as a share of GDP 6.09%

TEH Per Capita & GDP Per Capita in OECD Member Countries and Taiwan, 2005

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

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6500

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0 10000 20000 30000 40000 50000 60000 70000 80000

Taiwan

Iceland

Denmark

SwedenIreland

Finland

United Kingdom

AustriaCanada

Belgium

Australia2005Italy

Greece

France

New Zealand

Spain

Hungary

Portugal

Turkey2005

Poland

Germany

Norway

Korea

Mexico Slovak Republic2005

Czech RepublicGDP (Per Capita:US$)

Japan2005

Netherlands

Total Expenditure on Health by Financing Source, 2005

Out-of-pocket Health Expenditure

Out-of-pocket Expenditure by Provider, 2005

HP.2 Nursing andresidential carefacilities, 19,559,

7.6%

HP.4 Retail salesand other

providers ofmedical goods,

33.9%

HP.1 Hospitals,28.9%

HP.3.1 Office ofphysicians,

8.3%

HP.3 Providers ofambulatory health

care,29.5%

HP.3.2 Office ofdentists ,

13.7%

HP.3.3 Office ofother healthpractitioners,

3.8%

HP.3.5 Medical anddiagnostic

laboratories, 1,917,0.7%

HP.3.6 Providers ofhome health care

services,3.1%

Out-of-pocket Expenditure by Function, 2005

HC.4, HC.5,HC.6 & HC.7,

34.6%

HC.1-HC.3,65.4%

In-patientservices,

19.1%Day careservices,

0.1%Out-patientservices,

43.1%

Home careservices,

3.1%

Out-of-pocket Payments for Medical Care in Two Months

Variable Mean SD % of total

NHI cost-sharing: inpatient and outpatient 113 642 6.9

NHI cost-sharing: prescription drugs 14 63 0.9

Over-the-counter drugs 48 321 2.9

Extra-billing for inpatient hospital bed 356 6378 21.6

Extra-billing for laboratory and diagnostic 177 2449 10.8

Extra-billing for surgery 224 2173 13.6

Extra-billing for medical equipments or supplies

118 2305 7.2

Extra-billing for anesthesiology 68 820 4.1

All others 527 - 32.0

Total out-of-pocket payments 1645 19 264 100Note: All monetary values are in NT YuanReference: Chi C., Lee J-L., Tsai S-L., and Chen W-Y. Out-of-pocket payment for medical care under Taiwan’s National Health Insurance system. Health Econ, 2008; 17: 961-75.

Preliminary Analyses on Disease & Pharmaceutical Accounts

Personal Health Care Expenditure, Disease Specific, 2005

ATC Drug Expenditure, 2008_____________ATC____________________________________NT$(M)____Growth rateC Cardiovascular system 26,317 7.8%A Alimentary tract & metabolism 14,125 6.7%N Nervous system 14,097 6.0%J Antiinfectives for systemic use 13,961 6.6%L Antineoplastic & immunomodulating agents 13,306 17.9%B Blood & blood forming organs 9,549 9.0% M Musculo-skeletal system 4,713 0.7% R Respiratory system 4,622 -2.4%G Genitourinary system & sex hormones 2,589 7.2%H Systemic hormonal preparations (excl. sex hormon & insulin) 1,797 12.8%S Sensory organs 1,201 3.3% D Dermatologicals 1,167 -1.0%V Various 585 52.5%P Antiparasitic products, insecticides & repellents 160 3.0%___________Total 108,187 7.8% * Growth rates are compared with drug expenditure year 2007

On-going Works

• To refine data & information on OOP expenditures– A National Household Health Care Expenditure Surve

y

• To complete Taiwan’s SHA-based Health Accounts, Year 1999 to 2004 & 2006 to 2008

• To adjust with Consumer Price Index (CPI) & Medical Consumer Price Index (MCPI); or at constant year 2000 prices

• To interpretate the NHA’s policy implications

Thank You