a presentation about the study on e-health policy, made in Taipei, 2009

1. Information and Health Care Policy: A Case of Taiwan By Yuntsai Chu Don-yun Chen 2009

7. 4. The Case of Taiwan’s National Health Insurance (NHI) NHI Act Passed Global Budget First Party Turn-over First Presidential Election NHI Launched 2G-NHI Planning Begun Political Events NHI Events 3.6 3.5 2.4 2.5 2.1 1.6 ENP 2005-2007 2002-2004 1999-2001 1995-1998 1992-1994 1989-1991 Year Sixth Fifth Forth Third Second First Legislative Yuan

8. Source: The Website of the DOH, http:// www.doh.gov.tw /statistic/

9. Reforming the Pharmaceutical Procurement Mechanism in Taiwan: An Appraisal of the Experience in Taipei City Hospital

10. Table One: The NHI Total and the Pharmaceutical Spending, 1998-2004 ($, in Billion of New Taiwan Dollars) Source: The DOH, http:// www.doh.gov.tw /statistic/ 24.90% 24.60% 24.40% 24.80% 25.40% 25.40% 24.80% (B)/(A) 15.70% 4.30% 6.90% 2.20% 3.10% 11.30% 12.90% Increase % 109 95 91 85 83 80 72 (B) Drug Spending 14.10% 3.30% 8.50% 4.80% 2.90% 8.80% 11.40% Increase % 438 384 371 342 326 317 291 (A) NHI Total 2004 2003 2002 2001 2000 1999 1998

11. Figure Three: Annual Pharmaceutical Purchases in Taiwan Unit: 100 Million NTD 32% 20% 48% 3%

13. 6. The “Black Hole” of Pharmaceutical procurement Figure Two: The Pharmaceutical Cost and its Revenue X : the cost of a single drug for the manufacture Y : the net revenue for the manufacture (i.e., the reasonable plus the abnormal profits in imperfect competition) Z : the price difference between the listed price and final sale price of a single drug, that is, the net revenue for the health provides (hospital, clinics and physicians) X+Y+Z = the listed price of a single pharmaceutical approved by the BNHI, namely, the reimbursement value a hospital obtains from the BNHI by filing its purchase. X Y Z A B C D C*

16. 9. The Outcome of The Reform (I) Table Four: The Pharmaceutical Profits of the United Hospital Unit: NT$ thousand Source: interim report by the United Hospital, 2005 28.99% 25.40% 24.14% 21.48% C/A 2.99% 11.12% 13.61% 16.94% Pharmaceutical Profitability (D/B) 40,205 179,543 210,779 450,000 Pharmaceutical Revenues (D) 1,303,196 1,434,869 1,338,414 2,205,758 Pharmaceutical Expense (C) 1,343,401 1,614,412 1,549,192 2,655,758 Pharmaceutical Income (B) 4,495,156 5,648,371 5,545,025 10,268,565 Total Income (A) Jan.~Jul. 2003 Jan.~Jul. 2004 Jan.~Jul. 2005 2005

17. 10. The Outcome of the Reform (II) Table Three: The Pharmaceutical Procurement in the Taipei United Hospital Source: interim report by the Health Bureau (2005) 1272 (100%) 1312 (100%) total 684 (53.8%) 699 (53.3%) Generic/ off-patent (domestic suppliers) 588 (46.2%) 613 (46.7%) Original/ patent 2005-2006 2003-2004 Items

21. Thanks for your Attention Questions are Welcomed