Will the NHI’s new budget help the staff?

On Sept. 23, negotiations over next year’s National Health Insurance (NHI) global budget reached a conclusion. The NHI Committee set the growth rate for overall expenditure — encompassing hospitals, primary care clinics, dental services and traditional Chinese medicine — at 5.5 percent for next year. This pushes the total budget just above NT$1 trillion (US$31.46 billion) for the first time. It is the second consecutive year that an agreement has been reached to increase the budget, reflecting a consensus among medical professionals and payers on the need for greater investment in healthcare. The question is whether this additional funding can improve working conditions and help retain staff.

The negotiations included almost NT$5.8 billion in additional funding to improve nurses’ pay, which would be included in next year’s budget. How effectively this is allocated remains to be seen. The overall budget increase accounts for the demands of an aging population and rising medical costs. It cannot be treated as a surplus that hospitals and clinics are free to spend as they see fit. The scale of investment and how the money is used are two separate questions, and they are equally important.

Increased government reimbursements under NHI do not directly translate to higher wages for medical staff; healthcare institutions must first decide how to internally distribute the funds. Payment structures certainly affect institutional income, but it is ultimately management that has control over salaries, hiring and staffing schedules. When discussing staff retention, it is critical to ask not just how much the government is investing, but how employers are using the resources they receive.

When healthcare institutions “raise wages,” are these increases to fixed salaries or available bonuses tied to additional conditions? The Ministry of Health and Welfare has said that the average monthly salaries it publicly reports factor in non-regular payments. These averages alone cannot tell us how compensation has changed; if higher earnings are coming from working more night shifts and overtime, it cannot be claimed that working conditions have materially improved.

There are better ways to assess the effectiveness of retention efforts, such as measuring how much of the additional funding is being spent on personnel; how much fixed salaries have increased; and where the patient care workload per shift decreases after new staff are hired. Comparing salaries, actual working hours, vacancies and turnover rates is the only way to understand how much conditions for frontline workers have actually changed. It is worth examining whether or not improved pay for one professional group affects the salaries and workloads of others.

Clarifying how funds are distributed within institutions requires accounting for the different services provided and financial constraints faced by different facilities. Attributing all staffing shortages to the same cause should be avoided. However, responsible resource allocation can still exist under financial hardship; concrete measures for staff retention must be offered alongside explanations of cost pressures.

The NHI Committee’s consensus in negotiations completes just one stage of budget allocation. For frontline medical workers, the most pressing questions remain: Do salaries reflect the work they put in? Can they actually take time off? Can they see a stable future in the profession? It is the employers who control salaries and working arrangements that must provide answers to these questions.

Lu Chun-wei is a dermatologist and assistant professor at Chang Gung Memorial Hospital.