Health facility gets mixed review

A new respiratory care facility at Linkou's Chang Gung Memorial Hospital in Taipei County could help move longer-term patients out of intensive care (ICU) units at other facilities where resources are badly needed, hospital officials said yesterday.

At the same time, however, they disagreed on whether the plan -- eventually to include 20 such centers islandwide -- would actually ease resource burdens on the National Health Insurance plan as hoped.

"The Department of Health decided to [set up the center] because respiratory care patients are difficult to get out of ICU. Now they have an incentive because the Respiratory Care Center is more specialized," said Tsai Ying-huang (1/22熒?), a doctor and one of the center's directors.

Established in conjunction with the Department of Health (DOH), the new 24-bed facility is the fourth of its kind in Taiwan, said Justin Chang (張承能), head of intensive care at the hospital.

Encouraging patients on res-pirators to move directly from intensive care to a regular ward can be difficult, he said.

"As soon as you put them in a regular ward, the quality of care drops," Chang said.

Setting up this center as an intermediate or "step-down" facility offers specialized care at a lower cost to the National Health Insurance program than long-term stays in an ICU, Tsai said.

Chang, however, disagreed that the center would be cheaper for the health care system.

Treating chronic patients repeatedly, especially the elderly with often incurable ailments such as obstructive pulmonary disease, creates an undue burden on the health care system.

"Society, the country, and the government cannot afford to pay this forever," he said.

The center currently does not limit the number of times a patient may use its facilities.

Patients on respirators account for an average of 10 percent of those in intensive care, but this number is changing all the time, Chang said.

In addition to existing respiratory care centers, which include those in Hsinchu and Kaohsiung, the DOH plans to open as many as 20 centers in hospitals around the island, Chang said.

DOH financing helped the hospital buy equipment that would otherwise be beyond budget constraints, such as a NT$60,000 wheelchair equipped with a respirator which will help patients get around outside, Tsai said.

This wheelchair and other amenities are designed to raise the quality of care for the center's patients, most of whom face long-term hospital stays.

"Quality of care is not very important in Taiwan's hospitals. I hope this center will be different," said Lin Meng-chih (林孟志), the medical director of the center.