Sat, Dec 14, 2002 - Page 8 News List

Resource imbalances damaging health care

By Hsieh Wen-Hui 謝文輝

The imbalance in the distribution of medical resources between urban and rural areas is worsening, prompting much criticism. Large hospitals frequently defend the situation as a normal state of affairs in a market economy. The public vote with their feet, they say, and the government should not interfere.

It is indeed a matter of market economics when large hospitals use their massive purchasing power to press medical suppliers to make drastic price cuts. It's also a matter of market economy when large hospitals tell doctors during salary negotiations that their wages are only about half that of their colleagues at regional hospitals outside urban areas because living conditions in urban areas are much better.

Large hospitals demand higher payments for their services by stressing their original mission of treating serious illnesses. But then they make every effort to attract people with minor illness, expanding their outpatient services in order to boost business.

This exercise in "hanging up a sheep's head but selling dog meat" (掛羊頭,賣狗肉) -- to use the old Chinese idiom -- smacks of the worst aspects of market economics.

The massive marketing efforts involved in attracting patients are an abuse of the hard-pressed National Health Insurance (NHI) program, which is a public asset. Unfortunately, both the Department of Health (DOH) and the Bureau of National Health Insurance (BNHI) are just sitting back and watching the problems develop.

It is particularly bewildering that large hospitals never talk about the principles of market economics when billing the bureau for health insurance payments. They purchase large amounts of medical supplies at low prices, in the manner of hypermarkets. Why don't they charge the bureau wholesale prices, instead of charging the same prices as regional hospitals and saying that it's the "standard medicine price."

Their various services are much more expensive than in regional hospitals -- disparities in cost and range of provision notwithstanding. What kind of market economy is this?

In fact, it's a thoroughly unfair market that guarantees the dominance of the large hospitals.

Obviously, the national health program is a "half-baked" market economy. Not only have the DOH and the bureau long ignored this unreasonable sate of affairs, but they have also frequently echoed the large hospitals' claims. They have even demanded that the regional hospitals strive to improve their quality.

All this fosters the impression in the regional hospitals that both the DOH and the BNHI are run by the large hospitals.

In this kind of healthcare market, it is too easy for large hospitals to push aside any hurdles to their prosperity, a fact which lends undue credit to health authorities.

If the situation continues, regional medical institutions will gradually shrink in size and then disappear. Convenient medical treatment and emergency care in rural areas will fall by the wayside. The wider costs to society generally will increase substantially as people start to have to make long and difficult journeys to get treatment.

It would be a tragedy if we were to make that became the reality in Taiwan's rural areas.

It is particularly worrying that the quality of care for patients with serious illnesses could decline significantly if large hospitals do not attend to their proper duties while feverishly soliciting patients with minor illnesses.

This story has been viewed 3740 times.

Comments will be moderated. Keep comments relevant to the article. Remarks containing abusive and obscene language, personal attacks of any kind or promotion will be removed and the user banned. Final decision will be at the discretion of the Taipei Times.

TOP top