Fri, Jan 10, 2003 - Page 8 News List


Investing in health care

Many of us watched with consternation as the clowns in our legislature locked horns and quarreled shamelessly over the health-care budget, without any consultation with health-care professionals.

With a dwindling budget in its coffers, the Department of Health came up with the mind-boggling "global budget" plan.

This is how it works: Take Hualien for example. The Health Bureau would say, "You have 300,000 people and we are giving you NT$1 billion a year. If you go over budget, you are on your own."

Of course, like any other government-sponsored programs, the budget is only enough for the first 10 months of the year.

This has turned the medical field into one of the fiercest battlegrounds. Hospitals bicker over budgets and physicians wrangle over payrolls. Facing diminishing budgets, many hospital choose to hire only part-time nurses and medical technicians, allowing them to cut costs by paying minimum wages.

It is estimated that more than 50 percent of nurses who qualified in 2001 still do not have a full-time job. Many hospitals are using part-time technicians to review women's Pap smear cytology, in place of board-certified pathologists.

Perhaps the most devastating ramification of our current health-care system is the birth of an entire generation of what I call "half-assed" doctors.

Put in simple terms, it pays more to see 50 patients in your clinic with a common cold than it does to perform coronary bypass surgery. Of course, it pays even more to do lasik eye surgery, botox skin injections, and colonic hydrotherapy, because these are entirely funded by the patient.

As a result, the brightest and the smartest from our medical schools are becoming dermatologists instead of neurosurgeons, sometimes practicing voodoo medicine instead of evidence-based science.

As a gastroenterologist, I see many young doctors who just want to learn upper endoscopy, which is straightforward and lucrative, neglecting procedures like biliary endoscopy, which is tedious and not profitable.

Many young otolaryngologists (head and neck specialists) just want to learn how to treat the common cold so they can rake in the dough by seeing 100 patients a day in their clinics, instead of training to operate on nasopharyngeal carcinoma.

This is what I mean by "half-assed."

With Taiwan's entry into the WTO, what if we have to import surgeons from China one day because our graduates don't want to spend their youth training to become surgeons in operating theaters, only to get paid less than a flight attendant?

I do not think money alone would solve the problem. But I do believe that we have to do more.

The US spends 15 percent of its GNP on health care, while Taiwan spend less than 5 percent of its GNP.

If we can shell out US$6 billion on the Aegis-equipped cruisers and another NT$200 billion on the pensions of retired civil servants, we can certainly invest more in health care for our graying population.

Kenny Liu, M.D.


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