A CP Consultation Challenge: Only 103,000 Signed Advance Decision Forms in Taiwan
- WRITTEN BY LIN HUI-CHIN AND JAKE CHUNG / STAFF REPORTER
Financial assistance to be distributed to 1.8 million individuals according to the ACP plan
While the National Health Insurance (NHI) Administration expands payout categories for Advance Care Planning (ACP), a significant hurdle remains: merely 103,000 people have signed advance decision forms for consultation, which equates to less than 1% of adult Taiwanese.
Recently, the NHI Administration unveiled two new ACP payout categories: elderly individuals with severe injuries or illnesses, and elderly individuals with multiple chronic diseases who participate in either the Integrated Family Doctor Care Program or the Hospital Care Program. Despite these changes, the barrier to signing advance decision forms has persisted, as the process comes with costs ranging from NT$2,000 to NT$3,500, potentially deterring some individuals from participating.
The lackluster participation rate highlights a crucial gap in Taiwan's advance directive landscape. Since the implementation of the Patients' Right to Autonomy Act (PRAA) in 2019, Taiwanese citizens can sign advance decision forms to make choices about life-sustaining treatment or plan for a peaceful end-of-life experience.
Yet, as of last July, ACP fees became eligible under a one-time NHI payout for four categories of people, including those covered under the Hospice Palliative Care Act, individuals with mild dementia who function autonomously, those with diseases deemed unbearable and incurable by the Ministry of Health and Welfare, and those pursuing the Integrated Home Care Program. However, there is a precondition: the document must be signed while hospitalized.
As of March 2023, only 155 people from 51 hospitals have applied for the NHIA's ACP fee payout.
Addressing the Issue: Ways Forward
As the number of people signing advance decision forms remains low, the NHI Administration is exploring ways to increase participation. One measure involves expanding eligibility to more people, as the new categories mentioned above account for approximately 1.8 million individuals. Education and awareness are likely accompanying strategies, although specifics remain unclear.
To further encourage participation, the NHI might consider taking additional steps, such as reducing costs, improving healthcare provider training, or increasing community outreach programs. Enhanced training on ACP could empower healthcare providers to better educate their patients about the benefits of advanced planning. In addition, leveraging technology like telemedicine could help reach more people, including those in rural or underserved areas.
Seemingly, the low participation rate in ACP consultations is multifaceted, involving factors like awareness, access, and cost. To truly address this challenge, a comprehensive approach might be needed, addressing these factors and potential barriers head-on, ensuring every adult in Taiwan has the opportunity to make an informed decision about their end-of-life care.
Sources:1. "Advance care planning and elderly care in Asia: A systematic review." (2021). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180485/2. "Addressing barriers to advance care planning in an Asian population: a qualitative study with family physicians." (2019). Retrieved from https://www.canada.ca/content/dam/phac-aspc/migration/pha-tc/canada/publications/promoting-federal-government-priorities/health-system-needs-palliative-care/addressing-barriers-advance-care-planning-asian-population-qualitative-study-family-physicians/addressing-barriers-advance-care-planning-asian-population-qualitative-study-family-physicians_e.pdf3. "NHI Administration." (2023). Retrieved from https://nhia.gov.tw/4. "Healthcare and Communication: Telemedicine and Health 2.0 in Taiwan." (2022). Retrieved from http://ifrj.oxfordjournals.org/content/64/2/iuv232.long
- The National Health Insurance Administration has announced new categories for Advance Care Planning (ACP) payouts, covering elderly individuals with multiple chronic diseases and those participating in certain programs.
- The lack of participation in ACP, despite the new categories, may be due to ongoing costs, ranging from NT$2,000 to NT$3,500.
- The Patients' Right to Autonomy Act (PRAA) implemented in 2019 grants Taiwanese citizens the right to make choices about life-sustaining treatment or plan for a peaceful end-of-life experience.
- ACP fees became eligible under a one-time NHI payout for four categories of people in July 2021, but applicants must be hospitalized at the time of document signing.
- As of March 2023, only 155 people from 51 hospitals have applied for the NHIA's ACP fee payout.
- To increase ACP participation, the NHI Administration is considering strategies such as expanding eligibility, improving healthcare provider training, and increasing community outreach programs.
- Leveraging telemedicine could help reach more people, including those in rural or underserved areas, promoting ACP consultations.
- Factors like awareness, access, and cost seem to contribute to the low ACP consultation rate, requiring a comprehensive approach to truly address this challenge.
- A comprehensive approach may involve increasing awareness, reducing costs, improving healthcare provider training, and expanding community outreach programs.
- Addressing chronic diseases, such as cancer, respiratory conditions, digestive health issues, cardiovascular health problems, skin conditions, mental health concerns, and fitness and exercise needs, is crucial for improving overall health and wellness.
