Following a period of silence, the question of medical exchanges between Taiwan and China has once again come to the fore, after Taipei Mayor Ko Wen-je’s (柯文哲) visit to Shanghai last month.
However, it seems the government’s plans to promote cross-strait medical exchanges and medical tourism is focused on pure economic interest, while it turns a blind eye on the possibility that such a system could be open to abuse. The government has also failed to consider what legal regulations or policies could be put in place to act as suitable preventive measures against malpractice.
Following its accession into the WTO — and in accordance with the General Agreement on Trade in Services (GATS) — Taiwan pledged to open its health service industry; the aborted cross-strait service trade agreement also contained a similar clause.
The problem with opening the medical industry to exchanges with other nations is that the practice could have an impact on medical tourism, medical immigration and long-distance medical treatment, as well as international research. If bureaucratic systems and laws are not robust enough, it will inevitably have a far-reaching impact on the rights and interests of the public.
The extent of the flow of information on medical treatment between countries will have a direct effect on the prognosis and subsequent treatment patients would receive.
However, aside from the Cross-Strait Cooperation Agreement on Medicine and Public Health Affairs — which allows the exchange of information in the event of large-scale accidents — the regulations are inadequate. Also, it must be clarified under what circumstances each party would be responsible for medical treatment. This includes the case when a patient is transferred to another country for treatment: Would the doctor treating the patient abroad maintain responsibility for any follow-up or therapeutic care? Furthermore, if a dispute occurs during the treatment of a patient, would the government assume that since each side has different standards for determining clinical errors and compensation payouts, it should not establish any regulations at all — meaning that patients would be left to take on this risk?
As for the question of distribution of resources, there are few assessments on whether the opening of the medical industry to international exchanges will worsen the nation’s already unequal healthcare system.
The National Heath Insurance (NHI) system allows the reimbursement of self-paid medical expenses for treatment received abroad, but according to article 55 of the National Health Insurance Act (全民健康保險法), reimbursement is confined to “those afflicted with special illnesses ... or requiring local medical care due to unforeseen illnesses or emergency childbirth.”
There has been no discussion over whether the NHI system should pay for the treatment of Taiwanese who have been transferred abroad for medical treatment.
Given the prevailing trend toward globalization, the government is undoubtedly under pressure to open the medical industry to international exchanges.
The government needs to carry out an evaluation of and provide appropriate responses to the questions that might come up as a result of opening the medical industry. It should also plan complementary measures to avoid causing harm to both the rights and interests of Taiwanese and the nation’s medical insurance system.
Wu Chuan-feng is an associate research fellow at the Academia Sinica Institute of Jurisprudence.
Translated by Edward Jones
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