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KMID : 0861120160200020027
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Korean Journal of Oriental Preventive Medicine
2016 Volume.20 No. 2 p.27 ~ p.38
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The Health Insurance system and the Quality Improvement Policies for Chinese Medicine in Taiwan
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Kim Dong-Su
Kwon Soo-Hyun
Chung Seol-Hee
Ahn Bo-Ryung
Lim Byung-Mook
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Abstract
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Backgrounds : Taiwan has similar national health insurance (NHI) system for traditional medicine with South Korea. Recently, new quality improvement policies for traditional medicine is being attempted in Taiwan.
Objectives : This study aimed to review the Taiwanese NHI system for Chinese Medicine (CM) and introduce quality improvement policies. Methods : Research articles, reports, government publications and year books which handled traditional medicine system and NHI system in Taiwan were searched and collected. The authors analyzed and summarized the contents in a qualitative manner.
Results : In Taiwanese NHI system, CM procedures and medication for outpatients are reimbursed through a mix of fee-for-service and global budget payment system. CM shares 4% of total expenditure of NHI in Taiwan. Mostly, the expenses for procedures are reimbursed regardless of disease type, however, in the specialized program for quality improvement, CM doctors have to comply with standard operating procedures (SOPs).
Conclusions : Taiwanese NHI system implemented SOP-based new reimbursement system for CM. Yet, the scientific evidences for SOPs are not sufficient, it can be useful references when we develope disease related reimbursement system for Korean Medicine in South Korea.
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KEYWORD
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Chinese Medicine, Traditional medicine, National health insurance, Taiwan health system, Quality of health care
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