With a rapidly aging population and a cash-strapped National Health Insurance system, the government is paying more attention to the issue of “futile medical care,” treatment applied only to prolong life without a foreseeable cure or positive outcome, and the prospect of hospice care.
In a seminar held by medical groups yesterday, National Taiwan University Hospital (NTUH) Jinshan Branch Superintendent Huang Sheng-Jean (黃勝堅) made a presentation on how the community hospital he directs in Jinshan established the first hospice community in Taiwan.
Huang was assigned to the post by NTUH less than two years ago, when the hospital planned to initiate a pilot program promoting local, close-to-home healthcare and hospice community care in the district.
“Physicians at Jinshan branch don’t just stay in the hospital. They visit patients and their families at home and participate in community health-promotion activities to relate to local people,” Huang said.
The hospital is now employing the capitation payment system, which can be seen as a family practice system, Huang said, with a physician taking care of a number of patients closely instead of being visited by patients randomly.
The system works under the idea that pain prevention is more important than treatment, Huang added, stressing that this kind of preventive healthcare includes reducing the patient’s and their family’s suffering at the end of their life.
“Of the NT$570 billion [US$18.9 billion] healthcare expenditure paid by the NHI, about NT$170 billion is spent on futile medical treatment,” Huang said. “By operating preventive healthcare, including building quality end-of-life care and promoting the signing of DNR [do not resuscitate] to have ‘a good death,’ a lot can be saved, benefiting the sustainability of the NHI system.”
“The rate of the patients under end-of-life care that had signed the DNR was 9.2 per 1,000 last year, compared with a national rate of 6.3 per 1,000,” Huang said, adding that the number is expected to exceed 10 per 1,000 this year.