Control of nursing aides, cleaners and laundry workers in hospitals should be a key part of preventing the re-emergence of SARS, said Center for Disease Control (CDC) Director Su Ih-jen (蘇益仁) yesterday.
While the Bureau of National Health Insurance is pressing ahead with projects to curb the waste of medical resources, hospitals have responded to the bureau's increasingly stringent measures by outsourcing jobs to cut costs.
"The SARS outbreak has revealed the impropriety of hospitals outsourcing these jobs. Take [Taipei Municipal] Yangming Hospital for example. In its outbreak, doctors and nurses fortunately were not infected," Su said.
"However, nursing aides, who did not have proper disease-prevention outfits, roamed freely in hospitals and contracted the disease," Su said.
Probable SARS cases reached 680 yesterday, four higher than the previous day's figure. All of the four new cases came from Yang-ming Hospital. The number of deaths stood at 81.
Casualties among domestic and foreign nursing aides have been reported in hospital outbreaks.
According to Taipei City's Foreign Workers' Consulting Center, in Taipei Municipal Hoping Hospital alone, seven foreign nursing aides contracted SARS and three of them have died.
Reviewing the causes of SARS outbreaks in hospitals, Su criticized the facilities for failing to control the movement of workers doing outsourced jobs.
"These nursing aides, cleaners and laundry workers were not the hospitals' formal employees. The hospitals, therefore, could not efficiently manage these workers," Su said.
Su suggested hospitals bring back under their control all outsourced jobs in order to improve infection control.
"Nursing should be completely conducted by hospitals' professional health workers," he said.
Outsourcing was also cited in the Taiwan Health Reform Foundation's review of flaws in the country's medical system exposed by the SARS outbreak.
The foundation said that while it is the responsibility of hospitals to tend to patients, they attempted to transfer to the cost of caring.
"Hospitals should increase manpower to tend to patients and allocate more funds for health caring," the foundation said.
However, as the insurance bureau strived to cut spending in order to slow the national health insurance program's mounting deficit, it became more difficult for hospitals to expand their budget for hiring more professionals.
"We have been discussing how to solve problems incurred by our outsourced jobs," said a Hoping Hospital official.
"We have been thinking about how to manage nursing aides, cleaners and laundry workers. But to increase hospital manpower is very difficult, given that the insurance bureau has been so strict in controlling spending," she said.
Su said the health insurance program needs to be changed and that the public has to change its mentality toward medical treatment. People need to accept the fact that they have to pay more if they want better treatment, he said.
Lin Jin-lon (林金龍), a local branch manager of the insurance bureau, said hospitals did provide special nurses for patients who needed full-time care, but patients had to pay for the nurses themselves.
Most patients would rather hire private nursing aides because, while trained nurses charge NT$1,000 to NT$2,000 per day, private nursing aides cost only NT$800 to NT$900 a day, Lin said.