Efforts to promote the quality of medical care in emergency rooms in larger hospitals have fallen short of expectations, with the Department of Health (DOH) finding that people often use the emergency room as a convenient backdoor to medical care and are reluctant to transfer to smaller hospitals.
The department launched a project to alleviate strains on emergency rooms by scaling down the National Health Insurance (NHI) payout for emergency room diagnoses, as well as increasing the nighttime emergency room diagnosis fees from 20 percent to 50 percent.
The project also divided patients into four different categories, allotting the patients of each category a certain amount of time in accordance with the severity of their ailments, to more quickly facilitate the flow of patients.
Bureau of Medical Affairs Director Hsu Ming-neng (許銘能) yesterday said that the department had hoped to prevent overcrowding in the emergency rooms of larger hospitals by moving patients to the less-used emergency rooms of smaller hospitals. The hospitals were to be linked through an electronic platform.
However, some hospitals found that the inclusion of a computer in their emergency rooms only increased their workload.
According to Chang Chih-hua (張志華), director-general of the Taiwan Medical Alliance for Labor Justice and Patient Safety and an attending physician of the emergency room at Shin Kong Wu Ho-su Memorial Hospital, the problem was that patients did not want to transfer hospitals, and there was too much paperwork involved in transferring the patients.
One transfer would necessitate up to 40 minutes of logging data and as many as eight forms. Adding the time spent on the telephone communicating with the other hospital and describing the patient’s condition, the whole process could take an hour or longer, which is more than enough time for the emergency room staff to see to the patient.
Hospitals report to local department of health branches the daily number of emergency room patients, but hospitals are kept in the dark on the availability of beds, Chang said.
Patients always want to transfer to larger hospitals, so requests for spare beds are always refused, Chang said, adding that patients with only slight maladies take up most of the beds and hospitals are often unable to accommodate patients with real needs who come in later.
Cheng Shou-hisa (鄭守夏), a professor at National Taiwan University’s Institute of Health Policy and Management, said that due to the hospitals’ efforts to control budgets, they often only admit patients that require less care, causing other patients to check in at the emergency room and hope to be hospitalized from within the emergency room, Cheng said.
The unwillingness of patients to transfer is also a reason why large hospitals’ emergency rooms are so full. Some patients are stubborn and wait around for beds to become available, and after two or three days, they check out of the hospital rather than transfer, Chang said.
Despite the NT$300 offered by the department for transfers, there still is insufficient incentive for the hospital or the patients to transfer, Chang said, adding that hospitals also run the risk of disputes with the families of patients whose conditions have worsened after being transferred.
Chang said that since the public often treated the emergency room as a backdoor to medical care, the government should lower the NHI payout for emergency room diagnosis and treatment so people would have to pay a higher fee to discourage inappropriate use of the emergency room.
However, Chen Jih-chang (陳日昌), director-general of the Taiwan Academy of Emergency Department Management, said that lowering the payout for the NHI system would only punish patients that are less well-off.
The public is not familiar with medical conditions; what may appear to be a stomachache may simply be gastroenteritis, or it may be a precursor to a heart attack, Chen said.
However, Chen said that with the large number of patients crowding emergency rooms, it was harder to offer quality service.
Patients are scared of being ignored once they have been transferred, so even if it takes longer to fill out all the required forms, the hospital should be responsible and do so to assure patients that they are not being cast off and ignored.
Cheng also said that a possible solution to the problem was a new payout method for the NHI system and a whole new mindset concerning the use of emergency medical care, adding that if these two key points are not taken seriously then the issue will remain unresolved.