In the wake of abrupt resignation offered by Chang Hung-jen (
Following the community hospitals' impassioned plea to "bring Chang to trial" at their protest on Tuesday, Chang announced his resignation on Thursday. Premier Yu Shyi-kun urged him to stay on in his post, and Chang has yet to make a final decision.
"The National Health Insurance has a sacred place in my heart," Chang said at a press conference on Thursday night. "If we need to offer a sacrifice to the shrine of National Health Insurance, I am honored to be the sacrifice," Chang said, his eyes brimming with tears.
Chang came under fire for the controversial fixed budget policy, a new comprehensive policy the Bureau of National Health Insurance launched in July to regulate spendthrift hospitals and curb ever-growing medical expenditures.
To help guide patients with severe and chronic diseases to large medical centers and patients with minor illnesses to smaller hospitals, the Bureau set the reimbursement ratio between inpatients and outpatients for all hospitals at 45:55. Hospitals of every size compete for the 45 percent share of the total budget allotted to compensate hospital's spending on inpatients. Community hospitals, which tend to serve more inpatients, have difficulty competing with large medical centers for reimbursement funds.
"While they [the Bureau] give big hospitals NT$0.90 for each dollar they applied for reimbursement, they only give some of us [community hospitals] NT$0.50," said Hsieh Wen-hui (謝文輝), the head of the Association.
Hsieh said that the sharp disparity of the payments between large and small hospitals violates the spirit of national health insurance.
"The system is to make the richer pay more to help the less capable," Hsieh said, "yet under the current ratio, larger hospitals are getting wealthier while we are closing down ... They are robbing the poor to help the rich."
The Association apologized for the social unrest their protest sparked and backtracked on their demand to have Chang step down.
"Whether Chang will leave his post depends on his individual willingness and the Premier's decision," Hsieh said, playing down the Association's opposition to Chang.
"If hospitals see me as a stumbling block on the road to reforming the national health insurance, then my resignation will open a window for communication between the Bureau and hospitals," Chang said yesterday.
"It is not a question of professionalism," Chang stressed, "it is a question of trust."
The Director of the Department of Health Chen Chien-jen (
"We should not scapegoat him [Chang] for the cumbersome medical institutions," Chen said.
Chen admitted the 45:55 ratio is indeed unfair for smaller hospitals. He promised to offer other measures to balance the budgetary distribution in next few days.
Chen also said that the Department of Health will recruit a citizen panel to discuss how to increase the Bureau's revenue and to maintain the universal health insurance system.
Currently, three formulas among the thirty proposed by the Bureau are considered more viable. The three formulas are to raise insurance premiums, to increase patients' partial burden for medication and tests or to narrow the insurance coverage.
"We hope the citizen panel, a model of deliberative democracy, will help us thrash out a solution."
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