Since the Patient Right to Autonomy Act (病人自主權利法) took effect in 2019, the uptake rate for advance directives, also known as “advance decisions,” has fallen short of expectations, lower than 1 percent. That is mainly because the advance care planning (ACP) consultation costs about NT$2,000 to NT$3,500, which reduces people’s willingness to make living wills.
Although the Ministry of Health and Welfare’s Department of Health Affairs oversees the act, the ministry’s cash-strapped National Health Insurance (NHI) Administration is responsible for funding affairs related to it, and the administration has few dollars to promote ACP. The ministry should set up a separate budget for ACP promotion, to create more room for its development. It should not rely on the NHI for everything.
The NHI was expanded to cover ACP fees for people aged 65 or older with severe injuries or illnesses or multiple chronic diseases, who are now exempt from paying for the consultation fee, a change that it is estimated to benefit 1.8 million people. By doing so, the ministry is aiming to increase the number of living will signatories by 20,000 to reach its 40,000 goal this year. Still, a gap remains between that and the ministry’s original goal of covering the fees for everyone by next year.
The ACP differs from do not resuscitate (DNR) documents in that the latter does not require a consultation from a professional medical team, which makes the promotion of DNRs simpler and easier. Signing an advance decision needs to go through ACP conducted by a professional medical team, which naturally incurs costs, with people needing to pay NT$2,000 to NT$3,500 out of their own pockets for ACP first to sign an advance decision. That is why the signing rate is low.
To promote advance decision signing, the NHI Administration is now covering the ACP fees for those with mild dementia, and those older than 65 with major injuries or illnesses, who are not only hospice patients, but also included in the home-based medical integration program.
However, the number of people in that category is quite low. Even though the administration has expanded the scope of coverage to two more groups starting last month, the advance decision signing rate is unlikely to rise to a significant degree.
To promote advance decision signing, it is not enough to rely solely on NHI coverage. If the ministry is truly determined to boost the signing rate, it should make available additional funds to expand coverage, encouraging people to take an ACP and sign an advance decision.
In addition to budgetary funding, due to a labor shortage for the ACP consultation at some hospitals, people who make an appointment for the service might need to wait one to three months. Faced with staffing problems, the ministry should also come up with some incentives. Only with sufficient budget and staff for ACP can the government revitalize the advance decision signing rate.
Tsai Ming-chung is director of Fengan Polyclinic.
Translated by Eddy Chang
What began on Feb. 28 as a military campaign against Iran quickly became the largest energy-supply disruption in modern times. Unlike the oil crises of the 1970s, which stemmed from producer-led embargoes, US President Donald Trump is the first leader in modern history to trigger a cascading global energy crisis through direct military action. In the process, Trump has also laid bare Taiwan’s strategic and economic fragilities, offering Beijing a real-time tutorial in how to exploit them. Repairing the damage to Persian Gulf oil and gas infrastructure could take years, suggesting that elevated energy prices are likely to persist. But the most
In late January, Taiwan’s first indigenous submarine, the Hai Kun (海鯤, or Narwhal), completed its first submerged dive, reaching a depth of roughly 50m during trials in the waters off Kaohsiung. By March, it had managed a fifth dive, still well short of the deep-water and endurance tests required before the navy could accept the vessel. The original delivery deadline of November last year passed months ago. CSBC Corp, Taiwan, the lead contractor, now targets June and the Ministry of National Defense is levying daily penalties for every day the submarine remains unfinished. The Hai Kun was supposed to be
Most schoolchildren learn that the circumference of the Earth is about 40,000km. They do not learn that the global economy depends on just 160 of those kilometers. Blocking two narrow waterways — the Strait of Hormuz and the Taiwan Strait — could send the economy back in time, if not to the Stone Age that US President Donald Trump has been threatening to bomb Iran back to, then at least to the mid-20th century, before the Rolling Stones first hit the airwaves. Over the past month and a half, Iran has turned the Strait of Hormuz, which is about 39km wide at
There is a peculiar kind of political theater unfolding in East Asia — one that would be laughable if its consequences were not so dangerous. Chinese Nationalist Party (KMT) Chairwoman Cheng Li-wun (鄭麗文) on April 12 returned from Beijing, where she met Chinese President Xi Jinping (習近平) and spoke earnestly about preserving “peace” and maintaining the “status quo.” It is a position that sounds responsible, even prudent. It is also a fiction. Taiwan is, by any honest definition, an independent country. It governs itself, defends itself, elects its leaders, and functions as a free and sovereign democracy. Independence is not a
RSS