Case highlights healthcare flaws

Control Yuan members Huang Wu-tzu, second right, and Lee Shen-yi, third right, and others visit the Municipal Jenai Hospital, to meet with Chang Heng, right, speaking on mobile phone, former director of Taipei City's Department of Health, Hospital president Wu Chen-lung, left, and Hsiao Sheng-huang, second left, the hospitals chief of nurosurgery. PHOTO: CHU PEI-HSIUNG, TAIPEI TIMES

As the public outcry grows over the fiasco involving the refusal of Taipei hospitals to treat a severely injured girl last week, Taiwan's medical professionals are tormented by the possibility that the incident was not an accidental blunder, but a common occurrence.

The case has highlighted lingering concerns about medical misconduct, and many people want to know whether problems in the healthcare system are the result of individual negligence or part of a systemic flaw.

Unfortunately, experts say, there is no simple answer.

Now that the neurosurgeons at the Taipei Municipal Jen Ai Hospital have been made the subject of intense media scrutiny and finger-pointing, many people are satisfied that the "culprits" have been found and no longer care about delving into the truth of the matter.

"When a few doctors are made scapegoats for the medical system, it blurs the focus of the whole tragedy. The hospitals in Taipei who received calls for aid from Jen Ai and lied about the number of available beds should bear responsibility as well," said Liu Mei-chun (劉梅君), the executive director of the Taiwan Health Reform Foundation.

"When a few doctors are made scapegoats for the medical system, it blurs the focus of the whole tragedy."

Liu Mei-chun, executive director of the Taiwan Health Reform Foundation

According to some officials, Dr. Lin Chih-nan (林致男), who has been accused of lying about the case, is merely the first person to have been caught allegedly neglecting his patients. Taiwan's medical training is in urgent need of reform, these people say.

"We regret the mistake, and will do out best to improve ethical training in medical education," Department of Health Director-General Chen Chien-jen (陳建仁) said yesterday.

However, saving patients' lives requires not just dedicated doctors, but also hospital administrators who have set their goal as serving patients rather than generating profits.

Disgruntled about their growing financial deficits, many hospitals are now reportedly refusing to hire more health workers, and are regularly operating with inadequate staff levels.

"Normally, a nurse has to take care of five patients each day. A doctor has to see more than 100 patients every day. As the patients demand better service, health workers also demand that their bosses grant them more manpower," said Hsieh Yen-yao (謝炎堯), executive-general of the Academy of Law and Medicine (中華民國醫事法律學會) and former deputy president of the Koo Foundation's Sun Yat-sen Cancer Center (和信治癌中心醫院).

Is it true that the hospitals are too poor to afford more manpower?

Data from the Taiwan Health Reform Foundation appears to contradict the claim.

Although the total number of hospitals has decreased by 30 percent in the past decade, the number of medical centers with corporate backing has increased from 24 to 50 nationwide, a dramatic jump in mergers and expansion, the foundation, which is a non-governmental organization, said.

Also, as the Bureau of National Health Insurance puts a cap on insurance reimbursements for hospitals, many community hospitals prefer to admit patients with minor illnesses to those with severe or chronic diseases in an effort to drive down spending, health experts said.

"Since community hospitals do not offer services for patients with severe diseases, every patient rushes to the famed National Taiwan University Hospital or Taipei General Veterans Hospital. So you see, large medical centers are packed, while smaller hospitals are empty and going out of business. It is a question of unequal distribution of medical resources and patients' long-established behavior patterns," said Chen Ri-chang (陳日昌), president of the Council of Medical Science, who has been invited to lead the Taipei City Government's investigation into the incident.

It is an age-old, chicken-and-egg question writ anew.

How can a hospital provide quality medical service without sufficient income from patients and co-payments from the government?

And who will want to pay, if the country's medical system can't guarantee patients' health, or even a chance of saving a life?