Taiwan to expand referral incentives to ease hospital overcrowding

台灣將擴大轉診獎勵措施以緩解醫院壅塞

TAIPEI (Taiwan News) — The Ministry of Health and Welfare will ask the National Health Insurance Administration on Thursday to discuss increasing reimbursement for emergency patients temporarily awaiting hospital beds and providing financial incentives for hospitals that transfer patients to other medical institutions, per CNA.

The move comes amid renewed concern over emergency room overcrowding following the death of an 85-year-old woman who spent 12 days waiting for an inpatient bed at National Taiwan University Hospital.

Health Minister Shih Chung-liang (石崇良) and Liu Yueh-ping (劉越萍), director-general of the ministry's Department of Medical Affairs, visited NTUH on Wednesday to discuss emergency room congestion with hospital executives. Liu said after the meeting that Shih had instructed the NHIA to hold a meeting to discuss adjustments to payments for patients temporarily staying in emergency departments while waiting for inpatient beds.

Another focus will be incentives for downward referrals, in which patients are transferred from major medical centers to regional or district hospitals that can provide appropriate care. The ministry will consider whether to provide incentives to the hospital transferring the patient and the hospital receiving them, Liu said.

The policy discussion comes as NTUH and Chang Gung Memorial Hospital in Linkou have faced persistent emergency room congestion. Liu said the ministry plans to establish a demonstration project involving the two hospitals to strengthen regional medical cooperation, improve patient transfers, and increase public confidence in receiving hospitals.

NTUH plans 20-bed ward
NTUH has already announced several measures to reduce emergency room congestion. The hospital plans to establish a ward with an initial capacity of about 20 beds to accommodate patients who have been waiting in the emergency department for admission. The hospital may eventually expand the ward to 60 beds depending on demand.

The hospital said it will also increase monitoring of patients who remain in emergency observation for more than 72 hours, improve the frequency of bed-coordination meetings, encourage patients who are medically ready to leave to be discharged more quickly, and establish a faster referral channel with other hospitals, per PTS.

The health ministry said the measures are intended to improve patient flow through the hospital system rather than simply adding more beds at major medical centers. Liu acknowledged that one of the main obstacles to transferring patients is a lack of public confidence in regional and district hospitals.

Patients and their families sometimes reject referrals because they are unfamiliar with the receiving hospital or believe that care there will be inferior to that provided by a medical center, she said. "The public must feel that the receiving hospital is as adequate as the current hospital," Liu said, per CNA.

The proposed demonstration project will therefore focus on strengthening links between hospitals and improving coordination so patients can be transferred without compromising their care.

Hospital-at-home care considered
The ministry is also considering expanding programs that allow certain patients to receive acute medical care outside a conventional hospital setting. Liu cited "hospital-at-home" or acute care at home as one potential approach. Under such programs, eligible patients can receive hospital-level acute treatment in an appropriate home or institutional setting, reducing pressure on hospital beds, per CNA.

The ministry will first review previous pilot programs and identify measures that have proven successful before expanding them, Liu said. The goal is to launch the demonstration project no later than the end of the year, ahead of the winter period when emergency departments typically face increased demand.

Health Minister Shih has said the recent overcrowding problem should not be viewed as a nationwide emergency room crisis. He previously noted that most other medical centers in the Taipei area were not experiencing the same degree of congestion as NTUH.

The government is therefore focusing on improving patient distribution across the health care system, rather than relying solely on expanding capacity at individual medical centers. The proposed NHI payment changes and referral incentives will be discussed Thursday, while the broader demonstration project is expected to be developed over the coming months.