At the National Taiwan Univer-sity Hospital, there are often large numbers of patients waiting to be seen. Some doctors even ask for extra registration quotas for the day. Physicians can't bear to reject patients who have come from southern Taiwan and waited in line since dawn. But the quality of medical care will be affected if they endlessly extend registration quotas.
Apart from the crowded clinics, emergency units are seeing patients packed into tiny spaces waiting for beds in the wards. Even if the physicians try to transfer patients to other hospitals, many often do not want to leave because they hope to get a place in the original hospital.
If I was asked, "What is the most serious problem in Taiwan's health care system?" I would answer without hesitation, "the gap between urban and rural areas." Remedial measures will fail if we simply generalize that "people will go to where the best treatment is" instead of trying to solve the fundamental problems.
Why did the patient transfer system initially championed by the National Health Insurance program fail? Why are the small local hospitals closing while the big hospitals get bigger? If ordinary people could get reasonable medical treatment near their homes, why would they travel to queue up in front of big hospitals before daybreak? Why would they crowd into corners in emergency unit and hope to be admitted for in-patient treatment? When bed space is hard to find at the big hospitals, small and medium-sized hospitals are on the verge of closure. How should the National Taiwan University Hospital help to resolve this discrepancy?
The difference between teaching hospitals and non-teaching hospitals lies in the presence or absence of research and teaching functions -- not in the number of patients they treat. The social responsibility of the teaching hospitals, which have more resources provided by the government, is not merely to teach medical students and residents, but to provide on-job training to maintain the progress of the entire medicare system and keep the system abreast of the times.
Teaching hospitals should not be self-satisfied about having large numbers of patients coming for treatment. Their support for other hospitals should not be limited to sending out a few big-name physicians for consultations once a week or receiving transfers. Teaching someone how to fish is better than feeding him the fish you've caught. The mission of a teaching hospital should be effectively to transmit its experience, especially local clinical experience, to other hospitals, to help raise the standard of treatment nationwide. I also hope that colleagues in Taiwan's medical circles will see themselves as "knowledge workers" and take pleasure in a lifetime of learning, instead of trying to treat as many patients as possible. Otherwise, they risk harming their own health and neglecting their families even though they may have cured large numbers of patients.
Competition between hospitals is increasingly commercialized as they offer performance bonuses to encourage physicians to see more patients, do more operations and prescribe more check-ups and more drugs. Overemphasis on "performance," however, results in physicians being unable to concentrate on any kind of research or teaching. They fail to keep up with the latest knowledge and treatments.
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