Hepatitis B Testing Costs and Military Service Eligibility in Taiwan

Regarding hepatitis B?

Could you please tell me the cost of a hepatitis B test at your hospital? I tested positive several years ago and have not had a follow-up test since.
Is it necessary to have the hepatitis B test done more than once to determine if one is infected? Additionally, regarding the issue of military service exemption or alternative service due to liver disease, what specific liver conditions would qualify for such exemptions?

bruce, 20~29 year old female. Ask Date: 2004/11/02

Dr. Zhao Chongliang reply Internal Medicine

Taiwan has a universal health insurance system, where the payment standards for each examination are set by the National Health Insurance Administration, and all hospitals follow the same guidelines.
The differences lie in the specific tests ordered and the methods used.
For instance, the cost for testing Hepatitis B surface antigen (HBsAg) varies depending on the method: 80 TWD for the Latex method, 100 TWD for the RPHA method, and 160 TWD for the enzyme immunoassay.
However, physicians may also need to check for antibody production and the level of infectiousness by testing for anti-HBs, anti-HBc, anti-HBc IgM, HBe, and anti-HBe, with costs ranging from 110 TWD to 315 TWD for each test.
Additionally, to determine whether the condition is acute hepatitis, chronic persistent hepatitis, or chronic active hepatitis, liver function tests may be conducted, including GOT, GPT, ALP, Bilirubin (Total), Bilirubin (Direct), GGT, LDH, albumin, and total protein, with costs ranging from 40 TWD to 70 TWD for each test.
If the HBsAg is positive and the antibodies are negative, it may indicate an acute phase, necessitating a follow-up test.
If the antigen turns negative and antibodies begin to appear, it suggests a healing process.
However, it is important to note that if antibodies were present during the first positive antigen test, and the second test shows a negative antigen, it could mean that the first test was at the end of the acute phase, or it could indicate chronic active hepatitis is still ongoing.
There is also a possibility that the individual was initially in a state of chronic persistent hepatitis and subsequently contracted a stronger virus or a virus that requires the Hepatitis B virus as a co-infection, such as the Hepatitis D virus.
Therefore, multiple tests are necessary to differentiate between various types of Hepatitis B virus infections.
If someone is a Hepatitis B carrier without liver function abnormalities, they are still required to serve in the military according to the established standards.
The conditions for alternative service are not based on health issues.
Many individuals deemed "exempt from military service" during the military examination are actually placed under "re-examination" protocols, requiring regular follow-ups at military hospitals.
If they fail the re-examination, they must still serve.
If they have a suitable job at that time, they may risk losing it, so it is advised not to rely on luck.

Reply Date: 2004/11/02

More Info

In Taiwan, the cost of Hepatitis B testing is standardized under the National Health Insurance (NHI) system, which means that the prices for various tests are generally consistent across hospitals. For a basic Hepatitis B surface antigen (HBsAg) test, the costs can vary depending on the testing method used. For example, the costs can range from NT$80 to NT$160 based on whether the test is conducted using Latex, RPHA, or enzyme immunoassay methods. Additional tests may be required to assess the presence of antibodies and the infectiousness of the virus, such as anti-HBs, anti-HBc, and HBeAg, with costs for these tests ranging from NT$110 to NT$315 each.
If you have previously tested positive for HBsAg, it is crucial to follow up with additional testing. A single positive result does not definitively indicate chronic Hepatitis B infection; it may also reflect an acute infection or a transient state. Therefore, it is common practice to conduct follow-up tests to monitor the progression of the disease and to determine whether the infection is chronic or if the body is clearing the virus. The presence of antibodies (anti-HBs) alongside a negative HBsAg can indicate recovery from an acute infection.
Regarding military service eligibility in Taiwan, specific criteria are set for individuals with liver diseases, including Hepatitis B. If you are a Hepatitis B carrier but do not exhibit abnormal liver function, you may still be required to serve in the military. The conditions that may exempt you from service include chronic hepatitis confirmed by liver biopsy, liver cirrhosis, or acute hepatitis with significantly elevated liver enzymes (ALT levels exceeding twice the normal range).
If you are concerned about your eligibility for military service due to your Hepatitis B status, it is advisable to consult with a healthcare professional who can provide a comprehensive evaluation of your liver function and overall health. If your liver function tests indicate abnormalities, further investigations, such as a liver biopsy, may be warranted to assess the extent of liver damage and to determine your eligibility for exemption from military service.

In summary, if you have a history of Hepatitis B and have not had recent follow-up testing, it is essential to consult a healthcare provider for appropriate testing and evaluation. This will not only help in understanding your current health status but also clarify your military service obligations based on your liver health. Regular monitoring and appropriate medical care are vital for managing Hepatitis B and ensuring your overall well-being.

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