Sensationalist headlines about the healthcare system being on the verge of collapse may have more to do with attracting attention and selling newspapers than the real situation. Nevertheless, the healthcare system does have plenty of problems, including staffing, doctor-patient relations and discontent among healthcare workers, which are causing a crisis in the National Health Insurance (NHI) system. To avoid a gradual collapse of the healthcare system, the Department of Health recently convened a conference to review the state of the nation’s health services and come up with a strategy for resolving the crisis.
According to data gathered by the health department, the number of medical specialists in the country has increased 1.57 times over the past decade. Even in the field of gynecology and obstetrics — which is vulnerable to a falling birthrate and malpractice disputes — the number of practitioners has risen by 21 percent, while the number of practitioners in emergency medicine has shot up 322 percent.
So why is there a shortage of doctors in the so-called “big five” specialties — internal medicine, surgery, gynecology, pediatrics and emergency medicine? A health department analysis suggests that factors contributing to this shortage include the falling birthrate, a rapid increase in hospital beds, lack of incentives to join these specialties under the NHI system, over-frequent reviews and inspections, heavy workloads, high risks and an unattractive lifestyle. For example, four of these major specialties — internal medicine, surgery, gynecology and pediatrics — account for 85 percent of malpractice disputes, with 80 percent of the doctors involved facing criminal charges.
During the 17 years since the NHI program was launched, the healthcare market has developed in the direction of large-scale operations. The number of hospital beds has increased by 21,000 over the past 10 years. More than 60 percent of medical specialists now work in hospitals, including 38 percent of pediatricians and 87 percent of doctors specializing in emergency medicine.
Unfortunately, Taiwan has yet to establish a referral system, therefore patients are accustomed to visiting any hospital or clinic they like. There is a big overlap between the illnesses attended to by medical specialists in hospitals and those handled by doctors who run their own clinics, so these two groups of doctors compete instead of cooperating with each other.
It is common these days for doctors to see 50 patients in one clinical session. A lot of people think that this kind of healthcare quality is a product of the healthcare demand created by the system and doctors working hand in hand. No wonder that when the health department proposed a policy of increasing NHI payments for specialties that are in difficulty at the conference, it was immediately met with harsh criticism from one of the doctors present, Hsieh Yen-yau (謝炎堯).
“The medical profession needs to do some introspection. It should not blame members of the public for visiting doctors so frequently,” Hsieh said. “Doctors often ask patients to do follow-up appointments in order to get paid more examination and diagnosis fees ... A lot of doctors perform surgery at the drop of a hat, implanting cardiac catheters and stents.”
“It is an out-and-out scam,” Hsieh added.