Taiwan fines citizens more for importing cotton swabs than for drunk driving, while lifesaving heart-monitoring devices remain out of reach. It is a system that punishes the trivial and neglects the essential. In Taiwan, you can be fined hundreds of thousands of New Taiwan dollars for something as trivial as ordering cotton swabs from an overseas Web site. At the same time, patients who need lifesaving medical devices — such as long-term electrocardiogram (ECG) monitors that detect dangerous heart rhythms — often cannot get them.
Consider a recent case that made headlines: A woman was fined NT$100,000 for buying cotton swabs from Taobao two years earlier. The swabs had long since been confiscated and destroyed. Yet the penalty came years later, delivered with the weight of a criminal conviction. Strikingly, the fine is harsher than what a first-time drunk driver would face.
The comparison is absurd. Cotton swabs might cause a minor self-injury. Drunk driving can kill. Only in Taiwan’s regulatory logic does the answer to which one deserves the greater punishment come out upside down.
In Taiwan, the standard Holter monitor records heart rhythms for only 24 hours. Yet we know from international evidence that arrhythmias — including atrial fibrillation and dangerous pauses — are often intermittent and might not appear within such a short window. Multi-day or even two-week continuous ECG patches have been the norm in the US, Europe and even parts of China for years. The benefits are obvious: better diagnostic yield, earlier detection and potentially the prevention of sudden cardiac death.
Taiwan is not lacking the technology. Although the product came late, at least it exists — a small consolation and a sign of potential. In 2022, a local company launched a multi-day ECG patch, even winning a Taiwan Excellence Award. Despite the recognition, patients who might benefit from it often cannot get it — blocked by tight reimbursement rules, regulatory inertia or distribution barriers.
Some patients wait months for symptoms to be detected with outdated 24-hour monitors, enduring repeated hospital visits. In other countries, a simple patch worn for a week could provide answers in days. Clinicians are asked to deliver world-class care with second-tier tools, while regulators congratulate themselves for keeping “order” in the market.
Regulators defend harsh penalties on imports to stop profiteering and protect consumers. The logic collapses under scrutiny. If a patient imports a glucose monitor or ECG patch for personal use, who is harmed?
This imbalance undermines trust in the entire system. Patients with urgent medical needs hear that the latest devices — already made in Taiwan — are unavailable to them. They sense that the system is not designed for their health, but to protect entrenched distributors and preserve outdated market structures.
By sealing off access to advanced tools, the current framework delays diagnoses, prolongs suffering and risks preventable deaths.
Taiwan rightly takes pride in its healthcare system and its reputation for innovation. However, it risks becoming a place where excellence is celebrated, but withheld from patients. True reform means more than slapping fines on trivial infractions. It means opening pathways so patients and clinicians can access the best tools available — even if that means loosening monopolies and questioning outdated laws.
Protecting lives must matter more than protecting the market for cotton swabs. Taiwan has spent too long over-regulating the trivial, while neglecting the essential. It is time to flip the priorities and finally put patients first.
Chu Jou-juo is a professor in the Department of Labor Relations at National Chung Cheng University.
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