Fri, Aug 08, 2014 - Page 8 News List

Healing a failing healthcare system

By Chien Jien-wen 錢建文

The nation’s healthcare system is ridden with problems, and medical provision in outlying areas is on the verge of collapse. What lies at the root of all these difficulties?

Possible solutions promoted by the government include setting up international medical zones and establishing a diagnosis-related group (DRG) system. Will these things turn out to be poisons or remedies? What is the real solution for our collapsing healthcare system?

The first step toward finding an answer to these questions must be a review of the nation’s healthcare history.

Many public health experts took part in designing the healthcare system, and they made it clear from the start that the National Health Insurance (NHI) system would be a kind of social insurance. The Bureau of National Health Insurance, which has now become the National Health Insurance Administration, would have to be financially self-supporting, and it would have to raise insurance premiums if its revenue was not enough to cover its expenditure.

However, politicians, including both government officials and elected representatives, have often gone against this principle because of their own political interests. They often treat the NHI as a kind of social welfare, giving the public the mistaken idea that it is an “all-you-can-eat” service.

Government spending accounts for an ever-smaller share of healthcare spending. Government-run hospitals in outlying areas keep closing and the public healthcare budget is being neglected.

When it is talking to the public, the government says that the NHI is a form of social welfare, so it is OK to take as much as you need. However, when it is talking to healthcare providers, it says that the NHI is a form of social insurance that has to be financially autonomous and implement global budgets.

On the one hand, the government has the power to allocate resources, but on the other hand, it does not fulfill the responsibilities that a government should have in a public health system. The authorities have sat by and watched as healthcare provision becomes highly marketized. Only big corporate-owned hospitals can survive in the market, because they are able to cut their costs.

As local healthcare provision crumbles, patients crowd into larger hospitals, no matter whether they are suffering from major or minor illnesses, and this overcrowding has pushed emergency rooms to the verge of collapse.

The second historical factor to consider is that the NHI was hastily launched a dozen or so years ago to win votes, and without sufficient preparation. This resulted in the NHI adopting the same kind of contribution standards that have given rise to problems with other government programs such as labor insurance.

More than a decade has passed, but there have been only limited reforms. One result is that in many cases, different people doing the same amount of work are paid differently, while those doing different amounts of work are paid the same. How irrational are payment standards?

Let us look at South Korea, which politicians often cite in comparison with Taiwan. How much does South Korea’s national health insurance pay for premature infant care, and how much does the NHI pay? Only when Taiwanese travel abroad do they discover how cheap healthcare is at home, but have they fulfilled their obligations?

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