Newsletter

[ Vol. 8 No. 2 ] (May - August 2007 )
Reimbursement policy of nutritional support in TAIWAN

ABSTRACT
The Taiwan Society of Parenteral and Enteral Nutrition (TSPEN) has been founded for more than 12 years. Its members increased up to 1,200 in a short period of time after the Society was founded, which was due to a good reimbursement policy in Taiwan for the development of TSPEN. The Bureau of National Health Insurance (BNHI) in Taiwan was advised by TSPEN to pay the fees of TPN only for those hospitals, which were qualified by TSPEN. Under the confidence of both sides, TSPEN may propose the new policy of nutritional support in clinical practice and the standards for the new payment of nutritional costs to our government, and it ran regular accreditation for each NST every two years for the continuous payment from the BNHI. The reimbursement policy has run for ten years, and it resulted in many advantages.

Recently, the TSPEN sets up the quality control system (QOC) for each NST in addition to the original accreditation system. We believe that a good quality control is more important than the previous checking points with standardized manpower, paper records or academic publications. The items of quality control include the incidence of catheter infection, complications of enteral or parental nutritional support, and outcomes of enteral or parenteral nutrition, etc. The comprehensive social or national policy and system for NSTs or Society of enteral and parenteral nutrition will encourage them to be better and stronger. Though different country may have different policy, the Society has the obligation to negotiate with its government or at least with Minister of Health to get better reimbursement for their NSTs. On the other hand, each Society should set up a good system to improve the quality of NST before it gets confidence and trust from its government.

Key words: reimbursement policy, accreditation, qualification of control, nutritional support, total parenteral nutrition

INTRODUCTION
The WHO strategy is a much-needed call to look at the bigger picture of disease prevention and health, and we agree with that its implementation “could lead to one of the largest and sustained improvements in population health ever seen.”(1-5) A good policy will support to the development of an academic society. Taiwan Society of Parenteral and Enteral Nutrition (TSPEN) is lucky enough to get the reimbursement policy support of our Bureau of National Health Insurance (BNHI) for the payment of TPN’s fees in the hospitals since 1993. Most society of nutritional support in the world is only an academic society, and they seldom get formal policy support, especially for the certain expenses in medical care from their government. The reimbursement policy is important for any NST (nutritional support team), which may strengthen its function and get full support from its hospital.

THE FOUNDATION OF TSPEN
The TSPEN was founded in 1992, when it had only 4 hundred members. The percentage of members in society included 34% of physician, 28% of dieticians, 15% of nurses, and 18% of pharmacists. Originally, TSPEN was hard to get support form each NST or hospital in Taiwan. The growth of TSPEN needs to attract more members, and gets the supports by all hospitals including their NST. The interaction was bidirectional. One of the goals for TSPEN is to seek a good policy from its government, which can attract the support and joining of NSTs and their hospital.

THE ACCREDITATION OF NSTS BY TSPEN
The number NST in Taiwan were not many in the early 1980s, but it increased gradually after 1990s. The qualitification system of NST in Taiwan was started by TSPEN in the second year after it was founded, which includes that each NST needed set up their team including one set of physician, dietician, nurse, and pharmacist for each one thousand bed. It meant that a 4000-bed hospital at least should have 4 physicians, 4 dieticians, 4 nurses, and 4 pharmacists joining to the membership of TSPEN for one year before accreditation. The NST should have good record system of their patients receiving nutritional support, and had one or twice ward rounds or conference per week. Besides, each NST should have one presentation or publication about nutritional support per year. The accreditation was renewed per two years.

THE SUPPORT OF BNHI TO TSPEN
The BNHI in Taiwan was founded in 1993, which was designed for the payment of most hospital expenses of people who joined to the BNHI. The joining rate in Taiwan was over 98%. All the people could be covered for their expenses of out patient clinical or admission. The health healthy insurance was very successful from that time and people in Taiwan satisfied with it over 80%

REIMBURSEMENT POLICY FOR NUTRITIONAL SUPPORT
For the improvement of nutrition support quality in Taiwan, TSPEN seeked the support from our BNHI in 1993, and the response was positive. BNHI agreed with the proposal by TSPEN, which asked the BNHI pay the fees for patient’s total parenteral nutrition (TPN) only in the hospital, which passed the qualification by TSPEN. The reimbursement policy was very unique in the Asia or even in the whole world. TSPEN was very lucky to get such support, and it increased its member very fast and could run its member education course smoothly after this policy.

OUTCOME OF THE POLICY
After the reimbursement policy of nutritional support in hospitals, all the hospitals in Taiwan ask their NST member must join into TSPEN, and the annual fees were paid by the hospital. The hospital could increase their income for the fees of TPN paid by the BNHI. The advantages were bidirectional.

QUALIFICATION OF CONTROL (QOC)
The TSPEN begins to set up the quality control system - QOC for each NST in addition to the original accreditation system in recent days. We believe that a good quality control is more important than the previous checking points with standardized manpower, paper records or academic publications. The items of quality control include the incidence of catheter infection, complications of enteral or parental nutritional support, and outcomes of enteral or parenteral nutrition, etc. The comprehensive social or national policy and system for NSTs or Society of enteral and parenteral nutrition will encourage them to be better and stronger. Though different country may have different policy, the Society has the obligation to negotiate with is government or at least with Minister of Health to get better reimbursement for their NSTs. On the other hand, each Society should set up a good system to improve the quality of NST before it gets confidence and trust from its government.

CONCLUSION AND FUTURE
The experience to seek reimbursement policy from government of TSPEN would like to share with all the member of PENSA. Once any society can get certain support from a formal organization of its government, it will be a strong help and support to expand the society. The well development of each NST will be benefit for the improvement of nutritional care in each country.

REFERENCES
 

From
The 11th PENSA Congress
October 1-4 2005
Sheraton Grande Walkerhill Hotel, Seoul, Korea
Page: 183-185