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Health experts decry influence of for-profit medicine

A market-based, for-profit medical service introduced by health officials to curb costs in the ailing National Health Insurance (NHI) system has eroded public trust in doctors, according to physicians who attended a seminar yesterday.

The Public Rights Promotion Association convened the seminar to invite health experts to take the pulse of the over-commercialized health industry and find ways to rebuild trust between patients and doctors.

Disputes between doctors and patients often stem from the commercialization of medical service, physicians said.

"Relations between doctors and patients are no longer unmediated," said Lee Yuan-fang (李源芳), superintendent of the Miaoli General Hospital.

The problem, Lee said, is that some patients make unnecessary visits to hospitals just to make sure their health premium is well spent -- and doctors cannot turn these patients away, no matter how frivolous their health concerns.

"Doctors can't simply turn their back on them. [That would] violate the spirit of the medical profession," said Shih Chun-ming (施俊明), a cardiologist at the Taipei Medical University Hospital.

"Moreover, before the government placed a cap on each hospital's spending, the more patients you saw, the more money you earned," Shih said. "The NHI taught both patients and doctors to reap profits or gain advantages in the medical business."

As a result, many doctors inevitably become overworked. Shih, 41, has to see more than 60 patients in a single morning. Lee, a veteran orthopedist, has at least 200 people waiting for hours every day just for a brief diagnosis.

Official figures from the Bureau of National Health Insurance show that every person in Taiwan pays an average of 15.4 visits to hospitals each year.

Given the abuse of medical resources, it is hardly surprising that miscommunication often occurs between doctors and patients.

"When you have another 100 patients to see, you simply have no time to explain the treatment, the drug's effects or the therapy's risks to every patient," Shih said. "That could very often lead to misunderstandings between doctors and patients."

Shih recalled how he has received complaints when he did not give a brain scan to a patient with a mild bruise on his head, or when he prescribed anti-fever tablets rather than giving shots.

"As the practice of medicine becomes a commercial transaction, trust evaporates and bargaining sets in," said Democratic Progressive Party Legislator Hong Chi-chang (洪奇昌), who practiced psychiatry at Mackay Memorial Hospital.

Hong said that although markets work wonderfully for commodities like cars and computers, the free-market principle doesn't work in health care, where the goal should hardly be selling more hysterectomies or heart bypass surgeries.
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