Although the number of health workers has doubled in the past two decades, the nation still faces a shortage of staff in the fields of internal medicine, surgery, gynecology, pediatrics and emergency care, academics and health professionals said at a seminar last week.
Chiang Tung-liang (江東亮), a professor at National Taiwan University’s (NTU) College of Public Health, said that the reasons behind the staff shortage in the five fields were “very complicated” and could only be resolved by understanding the root of the problem.
According to his data analysis, covering the period from 1990 to 2010, the number of health workers in pediatrics has increased by 50 to 60 percent, with the number of doctors setting up their own clinics rising by 20 percent, Chiang said.
The increasing availability of pediatric clinics in small towns with low population densities has seen these clinics branching out from their own field of specialty, Chiang said.
A declining birthrate — down 20 percent over the past decade — corresponded with a 10 percent increase in the number of adult patients, reinforcing the trend, Chiang said.
Taiwan Pediatric Association director-general Lee Ping-ing (李秉穎) said that pediatricians are generally viewed by hospitals as a bad investment, because the overhead for maintaining pediatricians is high, but the income they generate is relatively low.
Lee said the problem lay with the Bureau of National Health Insurance, which he said had listened to other agencies, but failed to respect the opinions of medical professionals.
Lee cited as an example the difference between having a child and an adult undergo a nuclear magnetic resonance (NMR) procedure.
The adult will quietly stay put, but the child will not, he said.
Anesthesia may have to be administered for the procedure to be successful, but the bureau has removed such funding, he said.
The bureau has not factored in special circumstances that caring for children may entail, which means patients have to pay out of their own pockets, he added.
Comparing the payout for pediatric health checkups in different countries, Lee said that both Hong Kong and Japan had payout amounts three times higher than Taiwan’s, while South Korea’s was 2.5 times that of Taiwan.
Pediatricians also have to shoulder the responsibility of administering public-funded vaccines, but they have to fight tooth-and-nail for the bureau to reimburse checkup fees in their own clinics, Lee said.
This is just another example of “the higher the quality of medical care provided, the lower the income [of the provider],” he said.
Chiang suggested that the bureau should promote the concept of calculating expenses based on the individual receiving care, or the quality of treatment being provided.
The government should also encourage the forming of medical teams composed of pediatricians, obstetricians, internal medicine practitioners and family doctors.
With such a team, medical care would be provided for mothers and children from birth through their teenage years, Chiang said.
The association and 46 other organizations last year called on the presidential candidates to pass such a system, also known as the “children’s care doctor” system, Chiang said.
However, there has been no progress on the issue to date.
Both Tien and Huang voiced their support for the system, saying it would not only help provide healthcare guarantees for children, it would also be a great boon to new mothers, adding that they are considering a trial implementation of the system.
Aside from health professionals and academics, the seminar on Nov. 18 was attended by Department of Health Minister Chiu Wen-ta (邱文達), Bureau of National Health Insurance Director-General Huang San-kuei (黃三桂) and lawmakers across party lines.