As winter sets in, the number of stroke patients tends to increase. In response, Taiwan’s National Health Insurance Administration (NHIA) launched a “late time window” policy last year to extend the treatment period for ischemic stroke using thrombolysis and thrombectomy. According to the latest statistics, since the policy’s implementation, the number of thrombolysis treatments has increased by 27%, and thrombectomy cases have risen by 37%. NHIA Director-General Chung-Liang Shih announced on the 17th that starting in July this year, the NHIA has promoted a regional stroke defense network to encourage hospitals to establish treatment networks. Next year, the policy will be expanded to include teleconsultation measures and the establishment of a referral information platform to further improve the quality and efficiency of care.
Director-General Shih noted that stroke ranked as the fourth leading cause of death in Taiwan in 2023, with nearly 460,000 medical visits annually. Stroke-related healthcare expenditures reached 21.9 billion NHI points, with approximately 15% of stroke patients succumbing to the condition and 50%–60% experiencing severe disabilities. This imposes a heavy burden on individuals, families, and society.
Extended Treatment Windows for Ischemic Stroke
Ischemic stroke, the most common type of stroke in Taiwan, occurs primarily due to rapid blockage of cerebral blood vessels or embolism caused by large proximal vessel thrombosis. Starting October 1, 2023, the NHIA extended the allowable treatment time for thrombolytic drugs from 3 hours post-onset to 4.5 hours. On November 1, it further extended the treatment time for mechanical thrombectomy for acute ischemic stroke from the original 8 hours post-onset to 24 hours for anterior circulation strokes.
Since the introduction of the “late time window” policy, NHIA data shows that the number of thrombolysis treatments increased from 437 cases in October last year to 556 cases by August this year, a rise of 27.2%. It is estimated that annual cases could increase to 1,700. Similarly, thrombectomy treatments increased from 249 cases in November last year to 342 cases by August this year, a growth of 37.2%, with annual cases projected to reach 500.
Future Policy Directions
Director-General Shih stated that the “late time window” policy has significantly benefited patients. In July this year, the NHIA initiated a regional stroke network, encouraging hospitals to collaborate in treating stroke patients. For 2024, the NHIA will increase the budget for this initiative from NT$127 million to NT$268 million, designating it as a key task for all NHIA regional offices. The expansion will also include teleconsultation support measures and the creation of a referral information platform to enhance treatment quality and efficiency.
To ensure continuous post-stroke care and prevent recurrence, Shih highlighted the ongoing Post-Acute Care Plan (PAC) for stroke patients. This program provides integrated and holistic care. As of Q3 2023, 4,380 patients had participated, achieving a care success rate of over 90%. However, challenges remain for patients with atherosclerotic cardiovascular disease (ASCVD), a high-risk group for stroke. Data shows that only 35% of these patients achieve lipid management targets within a year post-stroke, with lipid testing rates at just 50% within six months and 70% within a year of discharge, indicating room for improvement.
Advancing Stroke Diagnosis and Monitoring
Shih emphasized the importance of CT perfusion imaging in stroke management and noted plans to explore additional reimbursements or bonuses for its use. Furthermore, the NHIA’s Medical Management Division is planning supplemental health insurance coverage for continuous blood flow monitoring in stroke patients.
In line with ASCVD risk management, Shih stated that the NHIA has started drafting a risk stratification program. From next year, patients classified as “very high” or “extremely high” risk, with a history of stroke, will be supported by incentives for hospitals to hire case managers. These managers will track patients’ medication adherence and control of hypertension, hyperlipidemia, and hyperglycemia to reduce the likelihood of recurrent strokes.
Insights from the Taiwan Stroke Society
According to Li-Ming Lian, President of the Taiwan Stroke Society, post-discharge care for stroke patients, including case manager support and health education, is crucial. Continuous monitoring of risk factors such as hypertension, hyperlipidemia, obesity, smoking, physical inactivity, and atrial fibrillation can lower the annual recurrence rate by 3.1%, potentially preventing over 1,200 recurrent strokes each year.
Resource: 腦中風治療晚時間窗成效佳 石崇良：明年將擴大這政策
