Obstetrics and gynecology departments across the nation are facing manpower shortages as fewer students choose to train as obstetricians and gynecologists, physicians and experts said yesterday at a conference in Taipei.
The Taiwan Association of Obstetrics and Gynecology (TAOG) and the Taiwan Association of Family Medicine yesterday held a seminar on the impact of the National Health Insurance (NHI) fund distribution policy, as well as how proportional physician fee (PPF) are doled out by hospital operators under the existing NHI system has contributed to the shortage of physicians in obstetrics and gynecology (ob/gyn) departments.
The distribution of physicians per specialty has always been imbalanced, Taiwan Woman’s Link director-general Huang Shu-ying (黃淑英) said.
However, according to data compiled by the Taiwan Medical Association, there was only a 5 percent increase in the number of physicians practicing obstetrics and gynecology in the 12-year period between 1998 and 2010, compared with a 35 percent increase in internal medicine and 40 percent in pediatrics, both of which are also considered to be unpopular departments among medical students, Huang said.
Along with the unequal distribution of NHI funds between departments, the NHI fee-for-service payment system is one of the main causes for the shortages, Huang said.
“The NHI pays less for similar procedures in obstetrics and gynecology than in other departments. For example, conducting both male genitalia and transrectal ultrasound exams pays more than transvaginal ultrasounds. The NHI also pays physicians more for doing general check-ups than it does for prenatal check-ups,” Huang said.
The government has increased its payments for outpatient services in surgery, pediatrics and obstetrics and gynecology departments by 17 percent, Huang said.
“However, I have been told by doctors that their salaries have not increased correspondingly,” Huang added.
The reason is that hospitals follow a “closed-system” operational model, meaning that the physicians are paid by the hospitals, instead of being paid directly by the NHI.
“The NHI bureau said it can only give payments to hospitals and has no say in how the payments are doled out or how the physician’s fees are paid within the hospitals,” Huang said.
Huang accused the health authority of “neglecting its duties” by failing to require hospitals to be more transparent in their financial reports, within which the payments to the employed physicians are included as part of the “personnel cost” under the category of “medical cost,” with no further details.
“It is also the physicians’ duty to stand up for their rights,” Huang said.
Huang suggested that the physician’s fees should be paid separately for better transparency and surveillance.
TAOG secretary-general Huang Min-chao (黃閔照) said that the NHI should make changes to the way it sets up contracts with hospitals, adding that the NHI should employ a pregnant-women-and-obstetricians centric payment system in order to establish perinatal holistic healthcare system and sustain the operations of obstetric clinics in rural areas.