NTU Hospital Head: NHI Should Also Be Reformed for Insurance Payouts for Day Surgery
Taiwan's Financial Supervisory Commission plans to revise insurance payouts for day surgeries. While the Minister of Health and Welfare sees this as a 'win-win-win,' the superintendent of National Taiwan University Hospital, Yu Chung-jen, calls for simultaneous discussion and adjustment of the National Health Insurance's DRG payment system, warning that day surgery may otherwise be difficult to implement.
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- 📰 Published: June 10, 2026 at 13:20
- 🔍 Collected: June 10, 2026 at 13:32 (12 min after Published)
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(CNA, Taipei, June 10, Reporter: Shen Yao-yao) The Financial Supervisory Commission (FSC) is set to review insurance payouts for day surgeries and other procedures. Although Minister of Health and Welfare Shih Chung-liang believes this is a win-win-win situation, National Taiwan University Hospital (NTUH) Superintendent Yu Chung-jen has called for a discussion and adjustment of the National Health Insurance's (NHI) Diagnosis-Related Group (DRG) payment model, warning that day surgery could otherwise be difficult to implement.
Many current medical insurance policies still require 'hospitalization' as a prerequisite for claims. The FSC is scheduled to meet with insurance companies this afternoon to conduct a comprehensive review of medical insurance claim rules, focusing on three major issues: the shift from inpatient to outpatient care, day surgery, and acute care at home, to consider whether policy benefits can keep up with medical trends.
Minister of Health and Welfare Shih Chung-liang, speaking to the media before attending the Legislative Yuan's Social Welfare and Environmental Hygiene Committee this morning, stated that they are actively communicating with the FSC regarding the practice of requiring hospitalization for related treatments under commercial medical insurance. He emphasized that this is a 'win-win-win' approach: medical costs can be reduced, patients will not be denied benefits due to changes in care models, and hospitals can improve bed utilization and alleviate staffing issues.
NTUH Superintendent Yu Chung-jen affirmed this, stating frankly that due to current claim conditions, many patients request hospitalization even for examinations, which 'makes no sense at all.' This is especially true for high-cost tests like next-generation sequencing (NGS), where the patient's financial burden can be significant without commercial insurance, even with partial NHI coverage.
Speaking to the media at an NTUH event, Yu Chung-jen said that the subjects of these tests are not the patients themselves but their tissues or blood. Yet, to get reimbursed, patients 'are hospitalized even just for a blood draw, which is unreasonable and causes clinical difficulties.' If the commercial insurance system makes a breakthrough, hospital clinical procedures could be comprehensively reviewed.
However, even with a breakthrough in commercial insurance, the current NHI system still requires patients to be hospitalized to receive benefits, which is an obstacle to the new day surgery system. Yu explained that many surgeries, including cataract and hemorrhoid surgeries, can already be shifted to outpatient clinics, but many are stuck due to insurance issues. In addition to policy adjustments, he hopes that the NHI's Diagnosis-Related Group (DRG) payment system can also be adjusted accordingly.
He emphasized that if commercial insurance claims and the NHI benefit model are relaxed, allowing hospitals to adjust their surgical procedures, it is judged that this will be of great help in alleviating pressure on hospital beds. (Editor: Chang Ming-kun) 1150610
Many current medical insurance policies still require 'hospitalization' as a prerequisite for claims. The FSC is scheduled to meet with insurance companies this afternoon to conduct a comprehensive review of medical insurance claim rules, focusing on three major issues: the shift from inpatient to outpatient care, day surgery, and acute care at home, to consider whether policy benefits can keep up with medical trends.
Minister of Health and Welfare Shih Chung-liang, speaking to the media before attending the Legislative Yuan's Social Welfare and Environmental Hygiene Committee this morning, stated that they are actively communicating with the FSC regarding the practice of requiring hospitalization for related treatments under commercial medical insurance. He emphasized that this is a 'win-win-win' approach: medical costs can be reduced, patients will not be denied benefits due to changes in care models, and hospitals can improve bed utilization and alleviate staffing issues.
NTUH Superintendent Yu Chung-jen affirmed this, stating frankly that due to current claim conditions, many patients request hospitalization even for examinations, which 'makes no sense at all.' This is especially true for high-cost tests like next-generation sequencing (NGS), where the patient's financial burden can be significant without commercial insurance, even with partial NHI coverage.
Speaking to the media at an NTUH event, Yu Chung-jen said that the subjects of these tests are not the patients themselves but their tissues or blood. Yet, to get reimbursed, patients 'are hospitalized even just for a blood draw, which is unreasonable and causes clinical difficulties.' If the commercial insurance system makes a breakthrough, hospital clinical procedures could be comprehensively reviewed.
However, even with a breakthrough in commercial insurance, the current NHI system still requires patients to be hospitalized to receive benefits, which is an obstacle to the new day surgery system. Yu explained that many surgeries, including cataract and hemorrhoid surgeries, can already be shifted to outpatient clinics, but many are stuck due to insurance issues. In addition to policy adjustments, he hopes that the NHI's Diagnosis-Related Group (DRG) payment system can also be adjusted accordingly.
He emphasized that if commercial insurance claims and the NHI benefit model are relaxed, allowing hospitals to adjust their surgical procedures, it is judged that this will be of great help in alleviating pressure on hospital beds. (Editor: Chang Ming-kun) 1150610
FAQ
金管會為何要檢討醫療險理賠規則？
為跟上醫療趨勢，金管會預計檢討醫療險理賠規則，特別聚焦於住院改門診、一日手術及在宅急症照護等議題，讓保單給付能符合現代醫療模式。
衛福部長石崇良對此政策的看法是什麼？
他認為這是「三贏」作法，能降低醫療費用，確保病患在照護模式改變下仍能獲得給付，同時幫助醫院提升病床運用效率並緩解人力問題。
台大醫院院長余忠仁認為落實一日手術的主要障礙是什麼？
余忠仁認為，除了商業保險的理賠條件需要調整外，現行的健保「住院診斷關聯群支付（DRG）」制度是主要障礙。他呼籲健保的支付制度也應隨之調整，否則一日手術難以真正落實。
現行保險制度造成了哪些不合理的醫療現象？
由於許多保險理賠以「住院」為前提，導致病人連做檢查（如抽血進行次世代基因定序）都要求住院以獲得理賠，造成臨床困擾與醫療資源的浪費。
哪些手術未來可能從住院轉為門診手術？
文章中舉例，包括白內障手術、痔瘡手術等都已經可以轉為門診手術，但目前常因保險給付問題而卡關。