The Graduate Institute of Medical and Biotechnology Law and the Center for Health and Welfare Policy Research at Taipei Medical University (TMU) hosted the "2025 National Health Insurance System Innovation Law Seminar" on April 8th. Scholars, experts, and guests engaged in lively discussions on the conference's themes: differential drug co-payment, telemedicine, and the implementation of corporate social responsibility within the National Health Insurance (NHI) system.

Dean Lee Chung-hsi of the TMU College of Humanities and Social Sciences stated in his opening remarks that the attendees spanned various fields, including law, economics, patient advocacy groups, and the biotechnology and pharmaceutical industries. This diversity highlighted the numerous issues requiring discussion and adjustment within Taiwan's NHI system, which has been in place for nearly 30 years. He expressed hope that the seminar would serve as a platform for experts from different fields to exchange ideas, spark more innovative and constructive solutions, and collectively shape a more sustainable future for Taiwan's NHI.

Professor Ho Chien-chih, Director of the TMU Graduate Institute of Medical and Biotechnology Law, presented his paper, noting that the differential drug co-payment system was first implemented in Germany in 1989, followed by over twenty EU countries, Canada, and New Zealand. The policy aims of differential co-payment are: first, to encourage the use of generic drugs; second, to promote price competition among manufacturers; third, to reduce government financial expenditure; and fourth, to guide manufacturers to improve drug efficacy. Empirical evidence from multiple countries over many years indicates that the differential drug co-payment system is generally more beneficial than detrimental. Furthermore, Japan in Asia also began implementing a differential co-payment system for original brand-name drugs in 2024 to control pharmaceutical expenditures. The Taiwanese government had considered implementing a differential drug co-payment system in 2015, but it was shelved due to public concerns. However, in recent years, support for the differential drug co-payment system has been growing among medical professionals, the pharmaceutical industry, and patient groups. Professor Ho also emphasized that to mitigate the impact of differential co-payment on vulnerable groups, laws could stipulate that children, low-income households, and patients using medication for rare diseases would be exempt from paying the differential, thereby both controlling NHI drug costs and safeguarding patients' access to medication.

Professor Sun Nai-yi of the National Taiwan University College of Law introduced Germany's reference pricing (differential co-payment) system within its Social Code. In Germany, the Federal Joint Committee sets reference prices for drugs based on expert opinions, and patients bear the cost exceeding these reference prices, with statutory health insurance not covering the difference. However, medications for children and innovative or patented drugs with significant therapeutic advancements are excluded from the reference pricing system. From a legal perspective, the reference pricing system constitutes indirect intervention in the pharmaceutical market, and the German Federal Constitutional Court has ruled that this intervention does not violate the occupational freedom of pharmaceutical manufacturers, thus deeming it constitutional.

Associate Research Fellow Wu Chuan-feng of the Academia Sinica Institute of Law explored the ethical considerations of the drug differential co-payment system. While the system aims to reduce drug expenditures and may to some extent provide patients with drug choice, it could also raise concerns about equality. Without appropriate supporting measures, a simple out-of-pocket payment model for the price difference might exacerbate inequality, leaving patients unable to afford the differential with only access to NHI-covered drugs. Furthermore, the criteria for including drugs in the differential co-payment category lack clarity, and concerns about the actual substitutability of drugs within the same class must also be considered. Associate Research Fellow Wu emphasized that by establishing measures such as reference drug groups and reference prices based on the principle of equal opportunity and while considering the premise of safeguarding basic health as seen in European and American countries, it might be possible to strike a balance between protecting patients' drug choice, ensuring the financial sustainability of the NHI, and upholding citizens' right to health.

Professor Hung Yi-chen of the Chinese Culture University Department of Economics pointed out that under the global free economic trade system, a single government cannot fully control market prices. From an economic perspective, "having choices" is at least no worse than "having no choices," and narrowing the scope of choice is actually detrimental to patients' rights and health welfare. Furthermore, Professor Hung emphasized that from a marginal benefit perspective, the distortionary effect of drug differential co-payment on the market is relatively small, and it is an effective way to find a reasonable balance between NHI financial pressure and patients' right to health.

Associate Professor Wu Chin-wen of the National Chengchi University Department of Law presented her paper introducing the legal frameworks of telemedicine policies in the European Union and France, which have received less research attention in Taiwan. Associate Professor Wu first pointed out that the policy objectives of Taiwan's telemedicine (remote consultation) system are unclear: Is it to enhance the competitiveness of medical services or to improve the convenience and access to medical care for the public through remote consultations? The purpose of telemedicine legislation is not explicitly stated in Taiwan's past regulations and orders. In contrast, the EU's 2005 policy clearly states that the purpose of telemedicine is to ensure the free movement of patients within Europe, followed by promoting "cross-border healthcare." The French Digital Health Act of October 19, 2010, categorizes telemedicine into five types based on function: teleconsultation, tele-expertise, telemonitoring, teleassistance, and medical response. In comparison, the categories of telemedicine accumulated in Taiwan to date are relatively fragmented. Moreover, Taiwan's telemedicine system is highly inclined towards a top-down, unilateral consent and decision-making model under traditional administrative authority, while regulations concerning public initiative and participation are relatively insufficient.

Assistant Professor Shan Hung-sheng of the Fu Jen Catholic University Department of Law pointed out that the permissibility and NHI reimbursement scope of telemedicine in Taiwan are handled separately, with certain restrictions on regions and specialties. For example, the specialties at the remote and local ends cannot be the same, which may limit the widespread adoption of telemedicine. Professor Shan also proposed three possible regulatory models for telemedicine: strict restrictions on eligible individuals and situations, exclusion of only first-time patients, and permission for specific cases.

Director Chen Yu-pei of the Traditional Chinese Medicine Department at the Ministry of Health and Welfare Tainan Hospital discussed the right to health and corporate social responsibility. Director Chen first explained that the right to health has been affirmed in Taiwanese law through successive interpretations by the Grand Justices. Secondly, Director Chen mentioned that Taiwan has also incorporated ESG principles into the Climate Change Response Act, the Company Act, the Securities and Exchange Act, and various labor regulations. Finally, Director Chen stated that the ESG concept, "take from society, give back to society," shares similarities with the principle of resource redistribution inherent in the NHI's social solidarity. Therefore, he suggested that companies causing pollution should be held responsible for the resulting health risks, and companies profiting from the production and sale of products that affect health risks (tobacco, alcohol, betel nut, and unhealthy food) should also be required to fulfill their social responsibilities. Concrete measures could include legislative amendments to implement taxation, special donations, and expanding the NHI's right of subrogation, using these funds to subsidize NHI finances and reduce the negative impact of businesses on public health.

Assistant Professor Tsai Wen-yi of the TMU Graduate Institute of Medical and Biotechnology Law reminded that companies should avoid greenwashing or sponsoring sports activities that promote high-sugar products when implementing social responsibility. Such behaviors may appear to fulfill social responsibility but fail to address core issues and may even damage brand image. If companies focus on the health sector and establish a deep connection with their core business, social responsibility and corporate growth can be mutually reinforcing. Furthermore, Professor Tsai used the example of American technology companies to illustrate how these companies emphasize employee mental health, incorporating it into their corporate social responsibility initiatives by providing medical insurance benefits superior to the Labor Standards Act and the NHI, and designing activities that promote employees' physical and mental well-being, achieving a win-win situation for both company growth and employee care.