As the Control Yuan censured government agencies for harsh working conditions at state-run hospitals last week, an article posted by a local nurse on CNN echoed the Control Yuan’s findings and explored the flawed payment system under the National Health Insurance (NHI) system.
In the article entitled “The dark moment of nurses in Taiwan,” nurse Maggie Lin refuted a recent CNN report that praised Taiwan for creating a high-quality system at stunningly low costs, blaming the system for transferring the cost to payrolls for medical staff and accelerating the medical manpower shortage.
Along with Lin’s article was a photograph featuring a nurse working while having an IV injection at a public hospital. A similar photo featuring a local nurse taking a nap while also having an IV injection at a hospital in Kaohsiung was carried in a Chinese-language newspaper earlier this month, revealing the exploitation that medical staff in Taiwan, nurses in particular, are facing at work — long hours, low wages and poor benefits.
In the investigative report conducted by the Control Yuan, state-run hospitals were found to suffer from a 9 percent manpower shortage. On average, a nurse working at a state-run hospital has to look after 13.5 patients, and work four to five hours overtime every day.
The manpower shortage has led to a heavy work load for hospital staff, while hospitals are facing difficulties in recruiting talented professionals because of this harsh work environment. This vicious cycle also affects the rights of patients, and the NHI should be held accountable for the damage done to the quality of medical service.
The system seems to have created a successful medical insurance mechanism that allows Taiwanese to receive treatment at low prices. However, the flawed payment system has contributed to an imbalance in the distribution of medical resources and made hospitals and health institutions more profit-driven.
Under the current system, the Bureau of National Health Insurance only gives hospitals about NT$0.85 for every NT$1 for which they seek reimbursement, leaving hospitals scrambling to balance their finances. In addition to cutting wages and reducing manpower, hospitals are turning to high-profit treatments such as plastic surgery and skin care, worsening the brain drain in major fields such as surgery, gynecology and pediatrics.
The lack of transparency in the financial activities of hospitals and health institutions due to poor government regulations and supervision further add to the plight.
The second-generation NHI will take effect in January next year, and once the system is launched, individuals will have to pay a proposed 4.91 percent of their regular monthly salary for NHI coverage, down from the current 5.17 percent.
Under the new NHI system, a 2 percent supplementary premium will be imposed on non-payroll incomes, including incomes earned from the following six sources: bonuses more than four times an individual’s monthly salary, professional fees, stock dividends, interest, rent and moonlighting.
While the government is expected to ease the financial burden of the NHI with an estimated increase of NT$20 billion (US$678.6 million) in annual health premiums, it must also re-evaluate the flawed payment system and balance the distribution of medical resources.
Government supervision of hospitals’ financial activities is also crucial to improve the NHI spending and prevent the commercialization of healthcare. A sweatshop-like working environment will not attract talented and dedicated professionals, and we expect the new system to step up and solve the problem of staff shortages as well as make the system more transparent.
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