Taiwan’s health insurance system provides a wide range of medical coverage, but as medical costs rise, some patients still face financial difficulties in paying for out-of-pocket drug treatment. Promoting patient support programs (PAPs) can further alleviate the financial pressure on these patients and improve access to new medical treatments. However, it is important for patients that the hospital understands and assists with the patient support program. From clinical care to streamlining the application process and proactively providing patient support information, better medical and financial outcomes can be achieved.
1. The importance of medication support programs
Although Taiwan’s National Health Insurance (NHI) already covers most of the medical expenses, there are still some high-priced new drugs and treatments that require patients to pay higher out-of-pocket costs. Patient Support Programs (PAPs) can provide patients who cannot afford the full cost of the necessary financial support and reduce the burden of getting the treatment they need, which is critical to improving access and equity for new medicines.
2. Challenges faced by hospitals
In Taiwan’s hospitals, it is relatively rare for hospitals to be unable to receive treatment due to poverty, as health insurance support covers most of the standard treatment, and the bad debt rate of hospitals is usually not high. However, for out-of-pocket medical treatment, due to the patient’s ability to pay, the patient needs to sign a self-pay consent form with the physician to clearly understand the financial burden before proceeding with the out-of-pocket treatment. Patients with different financial abilities are under different financial pressures, which motivates physicians and patients to make treatment recommendations and options together in clinical care to ensure the best shared decision-making process.
3. Raise awareness and reduce misunderstandings
There are some barriers to moving forward with patient support programs, including patients who do not know enough about the program or have no access to relevant information, or who mistakenly believe that they are not low-income and therefore ineligible. In the past, patient support programs were mostly derived from charity or mercy programs, but as the market has evolved, today’s programs are more based on the concept of continuous financial support, especially in cases where health insurance cannot provide drug support programs.
To overcome these obstacles, it is recommended that hospitals can increase patient awareness of support programs through advocacy and education. This includes proactively providing information about the program to let patients know why they may be eligible and should apply for it. This ensures that patients are informed in their treatment decisions and can choose the treatment that best suits their needs.
4. Simplify the application process
When a patient applies for a support plan, they are required to follow the hospital’s clinical procedures, including obtaining physician prescribing consent and necessary medical records and medication information. Considering the authorization requirements and compliance management of medical personal information, the application process is often quite cumbersome, especially the need to fill out the application form and attach documents, so that patients often need assistance to complete the application, which becomes another medical obstacle.
It is a patient-centric best practice to simplify and digitize application forms so that the information required for plan review can be digitally verified. This not only makes the hospital’s clinical work and plan applications smoother, but also helps to reduce the impact on the timeliness of medical care.
5. Proactively screen patients for eligibility
If the hospital can integrate and cooperate with the patient support plan, compare and screen the drug financial plan with the prescription content, so that eligible patients can apply for the PAP plan by the physician, so as to ensure that the patient’s treatment rights are protected. However, this approach requires the integration of health information systems with patient support planning systems in order to integrate planned medication into patients’ health plans.
6. Legislative trends and policy applications
It is suggested that Taiwan can learn from the practices of other countries to consider the application of patient support programs while considering the limited nature of health insurance subsidies, and provide clear administrative guidelines to promote the market to operate more efficiently. The new drug policy for public-private use allows hospitals to more effectively manage out-of-pocket drug payments, while providing better treatment and care for patients while waiting for health insurance applications.
7. The social responsibility and mission of the hospital
Providing inclusive medical care is an important part of the hospital’s social responsibility! In addition to community care and care for low-income families or special ethnic groups, reducing the financial burden on patients in combination with patient support programs not only helps to improve patient health outcomes, but also increases the credibility and satisfaction of the hospital.
─ Zhang Xiangxin, General Manager of PatientForce Caihong Health Integration Group
