The National Health Insurance Administration (NHIA) under the Ministry of Health and Welfare convened a joint planning meeting yesterday, announcing multiple new reimbursement measures to take effect this May. In addition to adjustments to emergency care payments, the approved measures include increased maternity reimbursements, expanded subsidies for advance care planning (ACP) consultations, inclusion of home hemodialysis under insurance coverage, salary adjustments for primary care nursing staff, expansion of the Enhanced Recovery After Surgery (ERAS) program, and the unprecedented inclusion of nutritional products for premature infants under insurance coverage.
NHIA Director-General Chung-Liang Shih stated that the newly approved reimbursement for breast milk fortifiers marks the first time the National Health Insurance system will cover a “food” item. Recognizing the unique nutritional needs of premature infants, the new policy will cover breast milk fortifiers for hospitalized newborns weighing less than 1,800 grams or born before 37 weeks of gestation. This new measure is expected to benefit approximately 2,200 infants and incur a total cost of NT$34 million.
The ERAS program, originally piloted in Taipei last year, showed promising results by significantly reducing postoperative complications and shortening hospital stays. Consequently, the program will be expanded nationwide this year. It will now be applied to patients aged 70 or older who are undergoing hip or knee replacement surgeries and are classified as high-risk (ASA Class III or IV) under anesthesia risk assessments.
Shih explained that ERAS reimbursement is structured around a multidisciplinary team that must include a surgeon, anesthesiologist, nurse, dietitian, and physical therapist. Preoperative assessments include evaluations of anesthesia risk and nutritional status, while postoperative care involves nutritional support and management of blood glucose and blood pressure. Each case will be reimbursed at 18,000 NHI points, with around 2,600 cases expected annually, at a projected cost of NT$50 million.
Third, the subsidy for advance care planning consultations will be expanded. In addition to existing beneficiaries—hospitalized patients aged 65 or older with catastrophic illnesses listed under palliative care, patients with mild dementia, those with designated incurable diseases, and participants in home-integrated care plans—two new groups will be eligible: individuals aged 65 or older with catastrophic illnesses, and patients with multiple chronic conditions enrolled in the Family Physician Program. Each eligible consultation will receive 3,000 NHI points, potentially benefiting 60,000 people at a projected cost of NT$180 million.
Fourth, improvements have been made to maternity reimbursements. Currently, the reimbursement rate for deliveries at primary care clinics is NT$1 per NHI point, but hospitals have not received equivalent treatment. This update ensures that hospitals will also receive NT$1 per point, with the change expected to cost NT$200 million. Additionally, natural births that occur at night or on holidays—considered unpredictable events—will receive a 30% additional reimbursement, similar to emergency surgeries. This is expected to cost NT$210 million.
Fifth, home hemodialysis will now be reimbursed at the same rate as in medical institutions, at 3,912 NHI points per session, with an additional 1,200 points for home visits and 420 points for telemedicine sessions. While the cost of the home dialysis machine will still be borne by the patient, annual expenses will be capped at NT$120,000.
Sixth, to address the lack of nursing reimbursements at primary care clinics, each of the first 30 patient visits per clinic will receive an additional 24 NHI points for consultation fees. Shih emphasized that clinics must use these funds to increase nursing salaries in order to receive the reimbursement. This measure is projected to cost NT$600 million.
Lastly, reforms related to emergency care were divided into four components, with a budget exceeding NT$4 billion. These include separating emergency consultation fees into physician and nursing components, each with a 10% increase; a 60% increase in observation bed reimbursements; upgraded reimbursement levels for emergency-designated hospitals—severe-level hospitals to receive medical center-level payments, and moderate-level hospitals to receive regional hospital-level payments; and tiered enhancements for emergency hospitals in offshore islands: 10% for basic-level, 30% for moderate-level, and 50% for severe-level institutions. In addition, the nursing fee for general acute inpatient beds will increase by 12–15%, depending on the hospital level.
Resource: 健保七大方案5月上路 首次給付「食品」照顧早產兒
