The fiscal deficit of National Health Insurance（NHI） has been a worrisome topic since the launch of National Health Insurance System in Taiwan. In spite of several times of copayment and premium hikes, just like a drop in the ocean, the widening fiscal gap of NHI still has not been filled up; and this dilemma has involved NHI in an operational crisis. Most researches on NHI policy have focused on exploration and solution of its fiscal issue. However, the success of policy implementation depends on several aspects not just one factor. Thus, the key point of this research is on the aspect of policy, and the research attempts to probe the present policy. In accordance with the theoretical framework of policy implementation; from the referral policy attribute itself and none referral policy attribute, the research analyzes the related factors that influence policy implementation. The purpose of this research, from the operational mechanism of NHI, is to find major factors that may impact on the performance of NHI policy. Furthermore, the research also tries to find the most feasibility with the best economic efficiency for the sustainable operation of NHI.
The methods used in this research included Literature-Review Method, Case-Study Method, and Interviews Method. Firstly, the research results of related literatures were reviewed and analyzed so as to establish the discourse of this research; the second step was to conduct a statistic analysis on a five-year case study of referral records; lastly, interviews method was used to conduct an empirical study. All of the empirical study, literatures information, and case statistic were collected and checked to conclude suggestions and summarizations.
The research found that referral system played an essential role in the medical care system of the advanced countries; and, the more advance in medical technology, the more referral cases in operation; compared with other advanced countries, a country with a well-established referral system, whose medical expenditures was nearly a half of the other countries’. According to Taiwan NHI statistical analyzing data, every year, there was 24-million-number of outpatients, who should have been referral, went directly to academic medical centers for health care. Because of the failure in referral, the NHI had to pay other NT$30 billions for the cost. Figures told a truth, to improve the fiscal deficit of NHI, practically fulfill referral policy may be an efficient solution rather than focusing on premium calculation.
In conclusion, Taiwan’s NHI performs the spirit of “reduction of economic barrier of medical care, promotion of accessibility of medical care” for patients; this insurance system has received well reputation in the world because of its high-quality-but-low-consumption policy. However, behind the glory, a severe insurance fiscal “black hole” is deteriorating the policy. Everyone agrees that the NHI must be existence; and in the viewpoint of international health care policy implementation, medical resources saving, medical expenditure control, and referral system implementation, all of which are useful solutions for securing NHI rather than just a copayment addition. To raise copayment of NHI to improve fiscal loss is one of tools; the result of the research suggests that the competent authority should take the specific medical system into account, strengthen the medical quality of physician clinics and dental clinics so that patients’ health care interests can be protected, then referral system implementation can be meaningful.