Authors' objectives: The widespread use of long-acting antipsychotic injections, strengthening of community management, and integration with the National Health Insurance payment system are potential strategies to enhance the strength of Taiwanˇ¦s mental health network. This project aims to: (1) Understand the current use of and evidence base for long-acting injections in Taiwan. (2) Learn from international strategies for community case management to strengthen case management within the mental health network. (3) Identify areas for improvement in the existing National Health Insurance Schizophrenia Treatment Payment Improvement Program. (4) Explore how these strategies can be integrated with the current National Health Insurance system to develop viable policies.

Authors' results and conclusions: (1) The consensus statement on the use of long-acting injections will help to update existing physician guidelines and gradually change old perceptions of long-acting injections among physicians and patients. (2) Hospitals struggle to manage cases that are not fixed or have not sought treatment for a long time, so more community care visitors, public health nurses, and home treatment resources are needed, and community psychiatric clinics should be encouraged to construct a complete community case management system. Early intervention in schizophrenia has proven effective in reducing subsequent disease burden in Korea and Singapore. (3) Financial incentives for physicians to use long-acting injections could be increased, following the example of acute ischemic stroke patients receiving tPA (tissue plasminogen activator). A dedicated fund for long-acting injections needs to be established. (4) Connectivity among existing case management systems should be enhanced by linking mobile apps to health insurance data and medical records to grasp patient movement within the case management system effectively. Similar to the diabetes payment improvement program, the existing National Health Insurance Schizophrenia Treatment payment system can be improved, and medical institutions can be encouraged to hire case managers to strengthen the connection with patients. Considering the unique characteristics and risks of mental illness patients for home treatment, the existing home treatment payment system needs adjustment. Encouraging early intervention in patients with schizophrenia can significantly reduce future medical and social costs.

Authors' recommendations: Considering the unique characteristics and risks of mental illness patients for home treatment, the existing home treatment payment system needs adjustment. Encouraging early intervention in patients with schizophrenia can significantly reduce future medical and social costs.

Authors' methods: This project utilized the Health and Welfare Data Science Center database to understand the current use of long-acting injections in Taiwan. We will conduct a systematic literature review to understand the evidence base for long-acting injections domestically and internationally and strategies for community case management. Subsequent discussions in multiple expert panels will address the current status, problems, and improvement plans of the National Health Insurance Schizophrenia Treatment Payment Improvement Program and how the above decisions can be integrated with existing health insurance policies to enhance policy implementation strength.

Project Status: Completed

Year Published: 2023

URL for published report: https://www.cde.org.tw/HTA/achievements

URL for additional information: English (Abstract) Full HTA report in Chinese (Mandarin)

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: Center for Drug Evaluation

Contact Address: 3F.,No.465, Sec.6, Zhongxiao E. Rd., Taipei 11557, Taiwan. R.O.C.

Contact Name: Li Ying (Grace) Huang

Contact Email: lyhuang277@cde.org.tw