Within their lawful authority, administrative bodies may engage private citizens, by entering into administrative contracts, for the performance of specific services in order to achieve administrative objectives and facilitate the execution of duties of administrative bodies, and such bodies* shall bear the corresponding obligation of payment or performance (See Article 137, Paragraph 1, Subparagraphs 1 and 2, of the Administrative Procedure Act). For the purposes of administering national health insurance, providing health services and promoting the health of all citizens (See Article 1 of the National Health Insurance Act), Articles 3 and 6 of the National Health Insurance Act authorize the Department of Health of the Executive Yuan to set up the Bureau of National Health Insurance as the insurer to administer the National Health Insurance program. Further, Article 55 of the said Act permits the Bureau to enter into a National Health Insurance Healthcare Providers Contract with healthcare providers for the provision of clinical or hospital care services, by the healthcare providers pursuant to Article 31 of the said Act and the National Health Insurance Medical Benefit Regulations, in the event of illness, injury or maternity, to beneficiaries during the period of insurance. The services so provided are the basis for payment by the said Bureau (See Article 2 of the National Health Insurance Act). The compulsory insurance system adopted for the National Health Insurance program affects all the nationals* well-being to a great extent and falls within the public law arena. The foregoing has been explicitly explained in this Yuan*s Interpretations Nos. 472, 473 and 524. By entering into the National Health Insurance Healthcare Providers Contract, the Bureau of National Health Insurance and the insurance healthcare providers covenant, on the part of the contracted healthcare providers, to provide medical services to the insured, and, on the part of the Bureau, to pay the approved service charges. Further, according to the provision in Article 1 of the said contract, the reason for payment by the Bureau is to promote national health and public benefits through the services provided by contracted healthcare providers, and they must comply with the laws of a public nature, i.e., the National Health Insurance Act and its Enforcement Rules, the Special Provisions and Management Rules for the National Health Insurance Healthcare Providers, and the National Health Insurance Medical Benefit Regulations, in their provision of healthcare services. To ensure fulfillment of contract obligations to perform medical services by contracted healthcare providers and their assistance in the said Bureau*s administration of health insurance matters, the said contract allows the Bureau to set guidelines for the performance of the contract. In addition, as a means to achieve administrative objectives, the National Health Insurance Act provides the Bureau with authority to discipline contracted healthcare providers, placing one party to the contract, the Bureau, in a privileged position. Thus, this contract has the attributes of an administrative contract, and any dispute between the contracting parties regarding the contents of the contract shall be governed by public law. According to the Article 2 of the Administrative Proceedings Act amended and promulgated on October 28, 1998, "A dispute under public law, unless otherwise provided by law, must be instituted under this law as an administrative litigation"; Article 3: "Administrative litigations referred to in the preceding Article are proceedings for revocation, confirmation and payment or performance"; and Article 8, Paragraph 1: "Where actions arise, under public law, between the people and the central or local authorities for payment of property or request for performance other than administrative acts, then proceedings for payment or performance may be commenced. The same applies to actions arising out of contracts governed by public law," the system for instituting proceedings is complete. Where the applicant of this Interpretation, the contracted healthcare provider, disagrees with the Bureau of National Health Insurance over the contents of the said contract, it is a matter of public law and the applicant shall apply for a review in accordance with the procedures set forth in Article 5, Paragraph 1, of the National Health Insurance Act. It is only when the applicant is unsatisfied with the result of the review that an administrative litigation can commence pursuant to the law.
The National Health Insurance Act was enacted on August 9, 1994. Its Article 5, Paragraph 1, provides: "There shall be a Disputes Settlement Board established under the National Health Insurance program to settle disputes arising from cases approved by the Insurer, and raised by the insured, the group insurance applicants or the contracted healthcare providers." Paragraph 3 states: "The insured and the group insurance applicants may file administrative appeals and administrative litigations if they disagree with the Board*s decision over the disputes in question." The remedy procedures to be followed in the event of the insurance healthcare providers* disagreement with the Dispute Settlement Board*s decision are not explicitly stated. There is no disagreement that the Bureau of National Health Insurance and the contracted healthcare providers have agreed, in the said contract, to submit to the jurisdiction of the Civil Court. However, since the enforcement of the new administrative litigation procedures, the parties shall now seek resolutions using the procedures for administrative litigations.