Wed, Jul 09, 2014 page8

• NHI system stuck in a rut with blame game

  • By Chen Liang-fu 陳亮甫
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  A series of medical-related issues have cropped up over the past few months. Arguments about whether international medical services should be provided in the proposed free economic pilot zones and whether healthcare should be profit-oriented have caused quite a clamor. In some medical litigation cases, medical service providers have been told to pay part of the litigation costs, while the diagnosis-related group (DRG) system is being implemented more widely in medical service funding.

  Factors such as these hamper doctors’ exercise of their medical expertise and the interests of seriously ill patients may be harmed when cost control is the primary concern. These arguments may seem to be independent issues, but the thinking behind them is the same, namely that the state is following neoliberal logic by implementing austerity across the board and contracting many public services out to private capital, while forcing workers and consumers to shoulder greater external costs.

  All these disputes show that when the state withdraws from its role in healthcare provision — thus weakening the National Health Insurance (NHI) and other systems that shared a portion of the burden of health costs — the public nature of healthcare must surely go into decline. Policies such as these are increasingly turning healthcare into industrialized and commercialized services.

  What must be made clear is that failings of the NHI should not be seen as an abject failure of socialism. Rather, it is privatization and over-extended free markets that have led to worsening work conditions because of the priority given to cost-efficiency, and led to increasing disparities in purchasing power among different consumer classes.

  Among people working in the medical field, the idea that the NHI will soon be bankrupt has come to be viewed as a politically correct position, but there is a great lack of imagination regarding alternative healthcare systems. Who benefits from the current situation in which the NHI system survives in name only? Putting off the crisis lends prestige and legitimacy to our rulers, while big hospital operators, who enjoy greater political bargaining power, stand to benefit from the austerity measures embraced by the DRG system, which seeks to exploit basic staff and consumers for profit, and squeeze out basic healthcare.

  The DRG system has come in for plenty of criticism, but it has gained the approval of hospitals for obvious reasons. Clinical staff and disadvantaged consumers stand to suffer, while hospital management may gain from its cost-control measures.

  Healthcare policy departments do not think about how to reduce medical waste in the healthcare system or improve the healthcare environment. All they care about is maintaining the NHI’s fiscal balance. Hospital management and government bureaucrats have acted in unison to ravage public property, causing basic staff to lose faith in the NHI and giving them no option but to move over to the profit-oriented market.

  Amid all the criticism of the NHI, there is an absence of any representative self-reflection about the medical field. The widespread anger among basic staff has not led to any rationalization of hospitals’ management systems. The possibility of unity among basic medical staff is drowned out by all the noisy grumbling. Worse, some health workers spend their time finger-pointing or blaming the public who are suffering just as much as they are, or else seek solace and indulge in self-pity through emotional comments and Internet posts. It is, after all, simpler and safer to moan about the NHI than to reexamine the system.

  That is why the NHI is stuck in a rut in which the weak and the disadvantaged waste their energies on blaming one another.

  Chen Liang-fu is a student in National Taiwan University’s Department of Medicine.

  Translated by Julian Clegg
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