Several emergency-room doctors at Linkou Chang Gung Memorial Hospital — which has the highest-capacity emergency room in Taiwan — last month tendered their resignations.
One of the doctors said the reason they resigned was because the hospital’s senior decisionmakers said that the emergency room loses too much money, especially since becoming government-funded.
To cut costs, hospital management decided to gradually cut back emergency services, including the number of observation unit beds and referrals.
This decision was seen as a declaration that the hospital is abandoning its core mission and ideals, and emergency-room doctors felt that they should just pack up and go home.
It is well known in medicine that 24-hour emergency services lose a lot of money.
However, even though National Health Insurance (NHI) reimbursements are nowhere near enough, it has long been the case that hospitals, based on their social responsibilities to serve the public good, divert surplus revenue from other departments to cover emergency-room expenses.
Profit-oriented managers often see emergency rooms as “prodigal sons.” The proper functioning of the whole healthcare safety net depends on conscientious healthcare workers, the government and hospital management, and they must act work to guarantee people’s right to medical treatment.
A medical center that makes massive NHI revenue does not use those funds to improve emergency and critical care services. Instead, it wants even bigger profits and implements further cost-cutting measures.
This sets a bad example for hospital management staff and if it exposes the reality that when corporate hospitals lose sight of their core values and become tools for grabbing at social resources, it is the start of a sad story for healthcare quality in Taiwan.
This incident should not be seen as one hospital’s internal problem, because it is a turning point in society’s perception of the responsibilities that corporate hospitals should bear.
If the government and public remain silent, it amounts to an endorsement of hospitals impairing medical treatment to cut costs.
Worse yet, if such decisions are not criticized, that is tantamount to acquiescing to NHI funds not being invested in improving healthcare quality and compensating medical workers for their professional contribution.
It would then be ironic to go on calling Taiwanese hospitals “not-for-profit institutions.”
Some hospitals in Taiwan were founded by businesspeople and some by people from the medical field.
Whichever the case might be, the founders believed in giving back to society.
Up until now, this conviction is what has allowed medical centers to be leaders in emergency and critical treatment quality.
Only if corporate hospitals could uphold and foster this ideal might they avoid becoming mere factories whose main concern is keeping costs down.
As founders die, this conviction seems to be forgotten. For hospital managers to make the decision to cut costs this way runs contrary not only to the spirit of the founders, but also to hospitals’ public image and their proper role in society.
Chen Wei-kung and Shih Hong-mou are chairman and secretary-general of the Taiwan Academy of Emergency Department Management.
Translated by Julian Clegg
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