The recent hike in the premiums of National Health Insurance (NHI) has generated a lot of controversy. Legislators, the media and consumer rights groups feel raising the NHI premiums in the absence of salary increases is a metaphorical stab in the public's back.
It is widely believed that as long as the practice of hospitals and pharmaceutical companies submitting inflated drug prices for NHI reimbursement could be eliminated -- more than NT$10 billion (US$312.5 million) per year -- the need for raising premiums would be resolved.
Are Taiwan's medical expenditures too high? Is the burden on the public too heavy? Are health care resources stretched too far? Part of the answer to these questions can be found through international comparisons. Such comparisons could also result in a more appropriate public response to the premium hikes.
According to this year's World Development Indicators Report published by the World Bank, total health expenditures as a proportion of gross domestic product (GDP) were 4.6 percent in low-income nations, 6.0 percent in middle-income nations and 11.2 percent in high-income nations. Taiwan is more or less a high-income nation, but according to Department of Health (DOH) statistics, the nation spends only 6.2 percent of GDP on health services. This means that there should be room for increased outlays.
Out-of-pocket health expenditures were 95 percent of total costs in low-income nations, 77 percent in middle-income nations and 37 percent in high-income nations. My calculation of Taiwan's out-of-pocket expense figure is 52 percent of total costs.
Generally speaking, Taiwanese pay less for health care than people in other countries. The public should feel that their health care services are cheaper than other nations, and this should be a source of some satisfaction. This is probably the reason why many Taiwanese living abroad often return to Taiwan for optional heath care services like dental work or plastic surgery.
When speaking of health care quality, however, we have to look at the number of physicians per 1,000 patients: 0.4 doctors in low-income nations, 1.7 doctors in middle-income nations and 3.7 doctors in high-income nations.
Taiwan's ratio of 1.4 is clearly on the low side and it is even lower than in middle-income nations. If the workload per physician is the same, then it is no wonder that people complain that doctors show a lack of respect for patients and often spend just a few minutes on each consultation.
Even though medical schools now accept more students, the supply of doctors in Taiwan is still lower than in European countries and the US. No wonder that the average income of physicians in Taiwan has been so high and that they have problems adjusting to today's global budgeting system.
It is of course difficult to increase the availability of doctors in the short term, but there are ways of improving the quality of their services. For example, both outpatients and inpatients could evaluate their health care services in compulsory surveys to be completed while receiving medication. For hospitals receiving a below average satisfaction rating, the NHI could adjust their payment level.
I believe this could help improve Taiwan's health care quality in so-called "not for profit hospitals" that inflate annual profits by letting their doctors receive up to a hundred patients a day -- in effect letting their assistants diagnose patients. It would greatly improve the quality of health care services for every Taiwanese.
Tu Jenn-hwa is an associate professor in the Graduate Institute of National Development at National Taiwan University.
Translated by Lin Ya-ti
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