The National Health Insurance Administration (NHIA) is evaluating the inclusion of various digital therapeutic products under health insurance coverage. Last year, the NHIA covered its first AI medical device, which is used for monitoring high-risk surgical patients. This device can predict hypotension 15 minutes before it occurs, effectively reducing postoperative complications and hospital stay durations. As of April this year, there have been 394 reimbursement claims. NHIA Director-General Chung-liang Shih stated that the agency is developing evaluation methods and considering temporary reimbursement, a health insurance sandbox, and simplified self-payment approval processes to accelerate the application of digital therapeutics.
Digital technology has the potential to enhance care efficiency and improve treatment outcomes. However, Chen Liang-gee, former Minister of Science and Technology and Chairman of the Taiwan Digital Health Industry Development Association, emphasized at the "Taiwan Digital Therapeutics Industry Development Trend Forum" that while Taiwan excels in wafer manufacturing and is a crucial supplier in the global AI industry chain, it remains relatively conservative in digital applications. Despite the government's recent efforts to promote industry development, a lack of comprehensive reimbursement mechanisms may deter investors, potentially limiting Taiwan to manufacturing AI components rather than advancing digital applications.
Temporary reimbursement systems in Germany and France
Kuan-hung Lin, an accountant with PwC's biomedical industry team, mentioned that according to international research, "reimbursement pathways" remain the most significant consideration for investors deciding whether to invest in biotech companies. Advanced countries such as Germany, France, and the UK have implemented temporary reimbursement systems. Japan, on the other hand, employs a review process similar to that for medical devices to evaluate and reimburse digital therapeutics, expediting their application.
Chung-liang Shih noted that NHIA is adapting its reimbursement strategies to keep pace with the times. Last year, it introduced a temporary payment system for new drugs, which now includes nine new medications. Digital therapeutics, however, are even more innovative than new drugs. Unlike traditional medications used for treatment and prevention, digital therapeutics also serve to "manage diseases" and can be integrated with other hardware, services, or drugs for optimized outcomes. Therefore, NHIA aims to develop new reimbursement models based on the value these products can create.
Apart from the AI medical device approved last year for surgical anesthesia, digital therapeutics can also provide enhanced care in chronic disease management, dosage adjustment assistance, and real-time monitoring feedback. However, NHIA must consider the return on investment, similar to an investment tool. Currently, digital therapeutics' business models can be broadly categorized into those directly facing patients and those facing medical institutions or system management platforms. Given that these are emerging products, NHIA is actively establishing new evaluation mechanisms, exploring temporary reimbursement or health insurance sandboxes outside the overall health insurance budget, and promoting simplified self-payment approval processes.
Resource (mandarin)
