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Appeals System and Its Outcomes in National Health Insurance in Taiwan
Swu‐Jane Lin, Shin-Chen Kuo, Yea‐Huei Kao Yang. Annals of Pharmacotherapy, 2006-02-28
Topic: Risk, prevention and care in population studies
A total of 12,237 cases of donepezil and 6975 cases of rivastigmine were submitted to the BNHI for prior authorization; among them, 72.6% of donepezil and 66.5% of rivastigmine cases received authorization. Among the thousands of cases denied prior authorization, 124 appealed to the DMC for dispute resolution. The result of the majority of the appeals (111 [89.5%]) was to uphold the BNHI denial decision. Most of the appeals were denied because of the lack of appropriate exclusion of other possible causes of dementia. Most appeals were again denied after expert review. Better education concerning utilization guidelines and a platform for insurer, insuree, and physician to dialog are needed to improve the effectiveness and efficiency of the appeals system.
Key findings
- A total of 12,237 cases of donepezil and 6975 cases of rivastigmine were submitted to the BNHI for prior authorization; among them, 72.6% of donepezil and 66.5% of rivastigmine cases received authorization.
- Among the thousands of cases denied prior authorization, 124 appealed to the DMC for dispute resolution.
- The result of the majority of the appeals (111 [89.5%]) was to uphold the BNHI denial decision.
- Most of the appeals were denied because of the lack of appropriate exclusion of other possible causes of dementia.
- Most appeals were again denied after expert review.
Why it matters
This study examined appeals after prior authorization denials for donepezil and rivastigmine in Taiwan's national health insurance. It found most appeals upheld the denial, often because other causes of dementia were not excluded, which concerns drug approval processes rather than treating or curing Alzheimer's disease.
Study details
- Participants12,237
- Effect size72.6%; 66.5%; 89.5%
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Annals of Pharmacotherapy) |
| Journal's citation record | 2 / 4 | Annals of Pharmacotherapy: journal h-index 153 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2006 — older than 20 years, still counted |
| Sample size | 4 / 4 | 12,237 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.3 citations a year over 22 year(s) since 2006 |
| Impact for its field and year | 2 / 6 | Cited 1.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Yea‐Huei Kao Yang: h-index 37 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Pittsburgh: institution h-index 1,470 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 16507607) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 41 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Lin, S., Kuo, S.-C., & Yang, Y. K. (2006). Appeals System and Its Outcomes in National Health Insurance in Taiwan. Annals of Pharmacotherapy. https://doi.org/10.1345/aph.1g437
Vancouver
Lin S, Kuo S.-C, Yang YK. Appeals System and Its Outcomes in National Health Insurance in Taiwan. Annals of Pharmacotherapy. 2006. doi:10.1345/aph.1g437. PMID: 16507607.
BibTeX
@article{lin2006-16507607,
author = {Lin, Swu‐Jane and Kuo, Shin-Chen and Yang, Yea‐Huei Kao},
title = {{Appeals System and Its Outcomes in National Health Insurance in Taiwan}},
journal = {Annals of Pharmacotherapy},
year = {2006},
doi = {10.1345/aph.1g437},
pmid = {16507607},
url = {https://doi.org/10.1345/aph.1g437}
}
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