Thu, Jan 27, 2005 - Page 8 News List

Patient `hot potato' a product of the system

By Hsieh Wen-hui謝文輝

The phenomenon of patients being transferred around to different hospitals like a human "hot potato" has existed for a long time, but it used to be a sporadic phenomenon. It usually happens when patients, or a patient's relatives, are hard to deal with. Patients who do not respond well to treatment or who suffer from complications are not welcome in a medical establishment where consumer interests take priority, especially when doctors fear malpractice suits.

To protect themselves, medical workers are motivated to shy away from responsibility. Patients are also likely to find themselves pushed away if they arrive at the hospital at "inconvenient times," such as late at night and outside business hours, when staff is short. Cases of this sort have attracted much media attention in the last year or so. It has affected all types of patients, but especially those who are critically ill or have rare diseases. This is why the topic is worth further discussion.

The recent scandal of delayed emergency treatment for a severely abused four-year-old girl surnamed Chiu brought into question the state of medial ethics and attitudes of medical workers, but it did not emphasize the underlying structural factors that caused this incident.

Human "hot potato" incidents shocked the public early last year when startling flaws in the health care system were reported. But why have such incidents suddenly become so numerous? Did the nation's doctors suddenly contract an epidemic that deprives them of medical ethics and professional responsibility?

Early 2004 saw the implementation of reforms in the national health insurance system. These reforms were introduced to cope with the system's financial shortfalls. A restricted budget payment system for all sectors of health care was put in place, and other plans focusing on individual hospital-based budgets, such as the hospital self-management program and the hospital excellence plan.

Under the new program, a hospital that was previously eligible for NT$100 per patient will now receive only NT$85. If hospitals continue to maintain normal services but do not raise money in other ways, their financial situations may deteriorate further. For the sake of financial survival, hospitals have responded to the government's health insurance budget cuts by reducing medical services.

If given a choice, people tend to opt for the easiest tasks possible. The increase in the instances of passing patients around like hot potatoes has emerged as a result of medical workers' decision to prioritize patients with mild ailments over those with critical illnesses.

What truly gives cause for worry is that the national health insurance system will now look after those with mild ailments at the expense of the seriously ill.

To prevent uncontrolled competition and waste of valuable medical resources, implementing individual hospital budgets is necessary. But supporting measures should be put in place to direct the actions of hospitals so that they meet the standards expected by the public.

One such provision would be to establish procedures to guide individual hospitals with a priority list for the allocation of their resources. This is the only way to ensure that the people who need treatment the most get it first.

The services of all hospitals should be designated and the allocation of resources prioritized. A reasonable allocation of resources must be decided upon so that these essential services will not suffer from reduced funding. This will ensure that the reduction of health insurance resources only affects non-essential services and that the phenomenon of the human hot potato vanishes.

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