Taiwan’s National Health Insurance (NHI) system is a very important means of maintaining the health of its citizens. Department of Health (DOH) Minister Yaung Chih-liang (楊志良) is determined to ensure that the NHI system continues to exist and develops over time, but so far he has not been able to find sufficient financial resources to cope with rising costs.
In the years since the inception of the NHI, it has become increasingly obvious to everyone that the system has many drawbacks that result in medical resources being wasted. This waste is caused not just by patients, but also by doctors and hospitals. At present, people go for treatment wherever they want, so that often no hospital or clinic holds a complete medical record for a particular patient. At the same time, consultation fees paid to doctors are low, so many make a living by seeing a large quantity of patients — in some cases as many as 200 to 300 a day.
Clearly proper treatment cannot possibly be provided in this way and eventually doctors run the risk of losing their skills. They may also not consider what tests are really necessary or whether they will be harmful to patients. Often they give in to patients’ demands by over-prescribing drugs. Hospitals, for their part, keep expanding and purchasing new equipment to attract more patients.
The existing NHI system has already damaged Taiwan’s healthcare environment. One effect has been that students at medical schools are reluctant to choose courses in surgery, obstetrics and gynecology or other high-risk disciplines, preferring instead to go into relatively low-risk fields like dermatology and ophthalmology. In other words, the medical profession is no longer focused on helping the sick.
The current debate over what form the second-generation NHI will take presents an opportunity for change. The first thing that needs to be done is to define what the NHI really is. If it is an insurance system, then various insurance schemes should be made available so that people can make a choice that best suits their needs. They would then have the option of paying different insurance premiums in return for different levels of treatment and care.
On the other hand, if the NHI is a welfare system, hospitals and clinics should serve specific areas and be classified, and a referral system should be put in place so that complete medical records can be held for each patient and they can be given the best possible diagnoses and treatment.
Still more important, the number of patients each doctor can see should be limited to, say, 30 per day, so that doctors spend enough time with each patient. Doctors should also do regular refresher courses to improve their skills. They should be paid regular salaries, taking length of service into account. As to medical disputes, they are inevitable, so a comprehensive system should be put in place to give both patients and doctors a reasonable level of legal protection.
If it is decided that the NHI is a welfare system, then the government should pay the full cost of healthcare for poor people. Of course education is important, too. People should be taught that the correct attitude is to go to hospital for treatment only when they really need it.
At this critical time, the DOH needs to once again bring together experts and academics to clearly define the role of the healthcare system and on that basis make the necessary changes in medical and general education. Only then will the NHI be able to get out of its present difficulties and achieve sustainable development in the long-term.
Sung Ruey-jen is chair professor at the Institute of Life Sciences, National Central University and a former dean of National Cheng Kung University College of Medicine.
TRANSLATED BY JULIAN CLEGG
With escalating US-China competition and mutual distrust, the trend of supply chain “friend shoring” in the wake of the COVID-19 pandemic and the fragmentation of the world into rival geopolitical blocs, many analysts and policymakers worry the world is retreating into a new cold war — a world of trade bifurcation, protectionism and deglobalization. The world is in a new cold war, said Robin Niblett, former director of the London-based think tank Chatham House. Niblett said he sees the US and China slowly reaching a modus vivendi, but it might take time. The two great powers appear to be “reversing carefully
As China steps up a campaign to diplomatically isolate and squeeze Taiwan, it has become more imperative than ever that Taipei play a greater role internationally with the support of the democratic world. To help safeguard its autonomous status, Taiwan needs to go beyond bolstering its defenses with weapons like anti-ship and anti-aircraft missiles. With the help of its international backers, it must also expand its diplomatic footprint globally. But are Taiwan’s foreign friends willing to translate their rhetoric into action by helping Taipei carve out more international space for itself? Beating back China’s effort to turn Taiwan into an international pariah
Typhoon Krathon made landfall in southwestern Taiwan last week, bringing strong winds, heavy rain and flooding, cutting power to more than 170,000 homes and water supply to more than 400,000 homes, and leading to more than 600 injuries and four deaths. Due to the typhoon, schools and offices across the nation were ordered to close for two to four days, stirring up familiar controversies over whether local governments’ decisions to call typhoon days were appropriate. The typhoon’s center made landfall in Kaohsiung’s Siaogang District (小港) at noon on Thursday, but it weakened into a tropical depression early on Friday, and its structure
Since the end of the Cold War, the US-China espionage battle has arguably become the largest on Earth. Spying on China is vital for the US, as China’s growing military and technological capabilities pose direct challenges to its interests, especially in defending Taiwan and maintaining security in the Indo-Pacific. Intelligence gathering helps the US counter Chinese aggression, stay ahead of threats and safeguard not only its own security, but also the stability of global trade routes. Unchecked Chinese expansion could destabilize the region and have far-reaching global consequences. In recent years, spying on China has become increasingly difficult for the US
RSS