Sat, May 19, 2007 page8

• Quality of healthcare is the thing that counts

  • By Andrew Huang 黃達夫
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  When healthcare officials talk about the National Health Insurance at home or abroad, they boast that there is almost universal coverage, and that the system is not only "cheap and abundant" but also "incomparably convenient" -- anyone can see a doctor anywhere without needing to wait.

  Yet, in his lecture "Creating a high-value healthcare system: Implications for Taiwan" on April 30, management guru Michael Porter said that while Taiwan's universal health insurance is an extraordinary achievement, insurance is only one segment of healthcare policy. The ultimate goal of the national health insurance policy is "protecting the health of all the people," and its most important task is to provide "high-value healthcare" for all.

  Value-based healthcare means it is best to prevent illness, or to detect illness at an early stage, quickly come to the correct diagnosis, give the right treatment at the appropriate time and avoid mistakes in the course of the treatment.

  What people should expect from health insurance is proper protection of their health; they should not be looking to receive more medicine, more health checks, or more treatment. Merely giving people a lot of medical services, said Porter, does not benefit them at all.

  Porter proposed a direction for the future. Apart from those hospitals that provide basic healthcare, different hospitals should specialize in the treatment of different major diseases. Also, quality should be determined by universalization, implying that no matter how many hospitals there are, they are of no use if they do not provide quality care.

  When people in the audience suggested that without universalization, convenience is lost, Porter gave this example: There are 139 hospitals that conduct heart transplants in the US. Some are good hospitals that have a lot of experience and a fatality rate in surgery of zero, and some are bad ones that only do a few operations a year, don't have much experience and have a fatality rate of 100 percent. In the end, it would be enough if there were only 20 or so hospitals left that offer this surgery.

  Of course, no one would choose a hospital that has a 100 percent fatality rate just because it is more convenient to get a transplant there. Therefore, when making decisions about life and death, convenience is the lowest priority.

  So why is it that the public is content with a healthcare insurance that boasts of being "cheap and abundant" and convenient, causing hospitals to use their size and equipment as an appeal?

  The problem is that the public lacks a standard with which to judge the quality of healthcare, so they believe "if the temple is big, there must be a god in it." "Cheap and abundant" healthcare means hospitals can earn more, and convenience means good service.

  Porter is of the opinion that no matter how cheap, bad healthcare is a waste. The most effective way to control medical expenses is by increasing the quality of healthcare, that's why the competition in healthcare will be competition in quality.

  Therefore, one of the main points of insurance reform is to establish a system for surveying the quality of care by setting up an information network. After that, the results have to be more transparent. A good health insurance system should also encourage the constant improvement and innovation in the healthcare system so that hospitals who improve get more resources.

  The most important thing is to give the public a basis to judge for themselves how good or bad a hospital is, giving them the opportunity to have more control over their own lives.

  Andrew Huang is the president of the Koo Foundation Sun Yat-sen Cancer Center.

  Translated by Anna Stiggelbout
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