Feasibility of Capitation for the Accountable Family Physician System: An Exploratory Study

The revised National Health Insurance (NHI) Act specifies in Article 44 that NHI should implement an accountable family physician system and the principle payment mechanism should be capitation. Since people in Taiwan have free choice of health care providers and the NHI payment system is predominantly based on fee-for-service, how to enforce the new law is a huge challenge. The purpose of this research is to explore the feasibility of expanding the existing “National Health Insurance Integrated Primary Care (IPC) Program” and applying a capitated payment to the program. In order to make a sound evaluation and inform future policy making, this study will utilize several research instruments including NHI documents and literature reviews, interviews and focus group discussions with key stakeholders. Specifically, this study will first describe the design and rationale the evolutions of the IPC program. Second, we will review international experiences and developments on capitated family physician policies and compare those with the IPC program. We will also review NHI documents and academic publications on the evaluations of the IPC program. Then we will interview key stakeholders and hear from their responses as to how they evaluate the IPC program, if it is appropriate to expand the current IPC program, what policy options can be considered and what issues should be addressed. In particular, how capitation can be successfully applied to the IPC program. Finally, we will make policy recommendations based on our observations.