Changing Medical Landscape and Rising Costs: Insurers Urge Prioritizing Reimbursement-Based Coverage

(Central News Agency reporter Su Siyun, Taipei, 6th) With rapid advancements in medical technology in recent years, medical centers are planning to introduce "day surgeries." Amid the trend of shorter hospital stays and an increase in outpatient surgeries, insurers are reminding the public that when planning medical coverage, they should shift from a mindset focused on hospitalization benefits to one centered on medical expense coverage, prioritizing a review of whether their reimbursement-based health insurance and outpatient surgery coverage are sufficient.

Fubon Life suggests that when planning medical coverage, the public should transition from the traditional "hospitalization benefit-oriented" approach to a "medical expense coverage" mindset, first checking for comprehensive reimbursement-based health insurance, and paying special attention to the scope and payment conditions for outpatient surgeries and related medical procedures.

For older health insurance policies primarily based on daily hospitalization benefits or inpatient surgery benefits, Fubon Life recommends that the public first reinforce their reimbursement-based medical coverage to bridge the gap for outpatient surgeries and out-of-pocket medical expenses. They can then add outpatient surgery-related coverage as needed, and also combine it with fixed-amount coverage such as surgery benefits, critical illness, or specific medical materials. For daily hospitalization benefits, they suggest building a complete structure through an allocation of "reimbursement as the mainstay, daily allowance as a supplement, and fixed-amount coverage for reinforcement."

Wang Caijing, Associate Manager of the Elite Operations Division at Leishan Insurance Broker, said in an interview with CNA that insurance companies' early health insurance policies indeed had flexible practices and did not strictly scrutinize the definition of hospitalization. However, in most current situations, if a patient does not go through the hospitalization procedure, it is generally considered an outpatient surgery. The continuous advancement of medical technology in recent years, the decline in hospital stays, and the increasing number of outpatient surgeries are already a trend.

Wang Caijing stated that many people's early health insurance policies may have emphasized daily hospitalization benefits, but the current thinking on insurance planning should shift from subsidizing room fees to being able to afford out-of-pocket expenses. She primarily recommends that the public increase the miscellaneous expense limit on their reimbursement-based policies, suggesting that the outpatient surgery limit be raised to NT$100,000. For inpatient coverage, she recommends that the combined limit for inpatient miscellaneous expenses and surgery be raised to NT$500,000 to better meet medical needs.

However, she also cautioned that if the public holds older health insurance policies that only cover inpatient items, they should not cancel them hastily. Although the coverage amount may be limited, it can still serve as a subsidy for lost wages or additional expenses during hospitalization.

Nan Shan Life stated that when people get sick, they often face three major risks simultaneously: medical expenses, loss of income, and long-term care costs. They suggest maintaining basic coverage for daily hospitalization benefits and surgery insurance, for example, a daily benefit of at least NT$3,000 and surgery insurance of 2 units, to cover costs such as major surgeries and room differentials.

Nan Shan Life stated that reimbursement-based health insurance supplements out-of-pocket items, surgeries, and medical miscellaneous expenses not covered by National Health Insurance. The lump-sum benefit design of critical illness or cancer insurance provides a flexible fund upon diagnosis, which can be used for out-of-pocket treatments, recovery period expenses, or transitional household expenses, helping to alleviate the financial impact of a major illness or injury. If the illness further affects work ability or even requires long-term care, long-term care insurance or dementia insurance can provide a lump sum or installment payments after conditions are met.

Nan Shan Life reminded the public that most surgical medical insurance products currently on the market already provide coverage for both "outpatient surgery" and "inpatient surgery," and reimbursement-based products also offer coverage with a limit for outpatient surgery expenses. They recommend regularly reviewing whether coverage is sufficient. (Editor: Lin Shuyuan) 1150606