Lai Ching-te Proposes Pay Overhaul to Combat Taiwan's Doctor Shortage

President Highlights Urgent Need for Healthcare System Reforms to Attract and Retain Medical Professionals

Taipei, March 29 – President Lai Ching-te (賴清德) on Saturday announced plans for structural reforms within Taiwan's National Health Insurance (NHI) system, aiming to address a growing shortage of physicians. The proposed changes include the adoption of a "different pay for different work" model, signaling a shift in how medical professionals are compensated.

Speaking at the 30th-anniversary event commemorating the introduction of the NHI in Taiwan, Lai emphasized the challenges the system faces, specifically highlighting financial sustainability and the difficulties in attracting and retaining healthcare professionals.

"Does the NHI have problems right now? Yes, it does. One issue is the sustainability of its finances, with the other being the difficulty in recruiting medical professionals," Lai stated, underscoring the urgent need for reform. He pointed out that the recruitment challenges extend beyond nurses to include doctors as well.

President Lai critiqued the existing fee-for-service model, where doctors are paid based on the volume of services provided, suggesting it needs review. He advocates for a "different pay for different work" model as part of the structural reforms to the NHI system.

"If doctors are doing different kinds of work but receiving the same pay, then of course, fewer doctors will choose the more demanding specialties," Lai argued, referencing demanding specialties like internal medicine, surgery, obstetrics and gynecology, and pediatrics.

While the specific details of the proposed "different pay for different work" model remain unclear, the announcement signals a potential shift in the approach to compensating physicians in Taiwan. A photo from CNA captured President Lai Ching-te speaking at the event.

Currently, the National Health Insurance Administration (NHIA) establishes an annual schedule for reimbursement amounts for various services. Shih Chung-liang (石崇良), the NHIA Director-general, indicated that adjustments to the reimbursement system are possible to address imbalances.

The NHIA is exploring dividing outpatient consultations into general and complex categories, with different reimbursement rates for doctors. Shih explained that some departments already utilize a resource-based relative value scale (RBRVS) to determine appropriate compensation, considering the varying time and complexity of surgical procedures across specialties.

However, Shih acknowledged that payments in some specialties may not be fully adjusted and that they will be reviewed in the near future.

In other developments, Shih also announced that starting May 1, the drug vosoritide will be covered by the NHI for young patients with achondroplasia, a rare genetic disorder affecting bone growth. The cost of the drug is approximately NT$7 million (US$210,839) per person annually, but Shih highlighted its importance in allowing patients to live normal lives and contribute to society. Approximately 72 young patients with achondroplasia across Taiwan are expected to benefit from the new NHI coverage.