Healthcare reform with payment incentives to increase cancer screening coverage in Taiwan

Background Taiwan expanded its cancer screening payment in 2010 and aimed to screen 55-70% of the target populations by 2013. Since 59-71% of the target populations had encounters with hospital(s), a nationwide initiative was launched in 2010 to help hospitals integrate screening into their clinical routines.

Method The initiative contained subsidy by program with targets of screening rates for hospitals; shared learning on organizational strategies; monitoring, feedback and public reporting of hospital performances; and pay for good performance. Hospitals' organizational strategies include leadership engagement, installing automatic assessment and screening, increasing screening capacity, and improving internal coordination and external collaboration.

Result A total of 232 hospitals which covers 92% of all hospital outpatient services applied and were granted subsidy for screening programs. These hospitals had a 1.8 times growth in screening volume in 2010 as compared to 2009, with 1.1 times, 2.1 times, 3.2 times and 15.8 times growth in screening for cervical cancer, breast cancer, oral cancer and colorectal cancer, respectively, while the volume provided by nonsubsidized hospitals and clinics in 2010 was 0.97 times that in 2009. An extra of about 3,200 cases of cancers and 26,000 pre-cancerous lesions were detected by these increased services.

Conclusion The nationwide initiative was adopted by a great majority of hospitals and successfully increased cancer screening volume within a short period which added remarkable lifesavings and helped hospitals transform themselves towards a healthier role.