On Sunday, 13 new urgent care centers (UCC) officially began operations across the six special municipalities. The purpose of the centers — which are open from 8am to midnight on Sundays and national holidays — is to reduce congestion in hospital emergency rooms, especially during the nine-day Lunar New Year holiday next year.
It remains to be seen how effective these centers would be. For one, it is difficult for people to judge for themselves whether their condition warrants visiting a major hospital or a UCC — long-term public education and health promotions are necessary.
Second, many emergency departments acknowledge that overcrowding mainly stems from a lack of nursing staff, which limits the availability of beds and leaves severely ill people waiting in the emergency room. Mild to moderate cases are not the primary cause of emergency room congestion. UCCs charge NT$150 for a visit, compared with NT$750 for an emergency visit at a major hospital.
This might provide some incentive, but a difference of just NT$600 might not be enough for people who are anxious about their health. For them, a few advanced tests might be worth the cost, and many could choose to bypass the UCC and head straight to the emergency room.
Taiwan’s healthcare accessibility is among the best in the world. People enjoy the freedom to seek care directly at major medical institutions without first seeking a referral. However, statistics show that the National Health Insurance (NHI) costs for outpatient visits at major hospitals are nearly four times higher than those of local clinics. Taiwan’s so-called tiered healthcare system has yet to be fully implemented.
The National Health Insurance Administration (NHIA) justified the establishment of UCCs by citing that about 80 percent of primary healthcare institutions across the nation remain open on Saturdays, but only about 20 percent operate on Sundays.
This reasoning is not entirely sound. Nearly no primary healthcare institutions are open on holidays in other countries, such as the US and Japan. Taiwan’s holiday opening rate for primary healthcare institutions is already quite high by comparison. In Japan, holidays are reserved for handling only severe emergencies, while mild cases — such as those UCCs are meant to treat — are typically not addressed. Taiwanese have grown accustomed to the low cost, accessibility and convenience of the NHI system and continue to use it extensively.
Public satisfaction with the NHI system exceeds 90 percent, and foreign visitors are often amazed by Taiwan’s high efficiency and low cost of medical treatment. Behind this success, however, are the hard work and sacrifices of the nation’s healthcare workers: It is because of this that the prestige once associated with the medical field has gradually dimmed, and the healthcare system has repeatedly faced threats of collapse.
Keeping in line with the spirit of a tiered healthcare system and considering that about 80 percent — about 9,600 — of primary healthcare institutions across Taiwan remain open on Saturdays, and about 20 percent — or more than 2,400 — operate on Sundays, the NHIA should implement two measures.
First, it should strengthen incentives for primary healthcare institutions to operate on holidays by modeling the reward system announced for the upcoming Lunar New Year holiday and multiplying consultation fees.
Second, it should consider implementing a mandatory referral system for tiered healthcare on holidays — people should be required to obtain a referral from a primary healthcare institution before visiting a major hospital or else pay higher registration fees and copayments. This system could then gradually be expanded to apply on weekdays.
Without such measures, it would be extremely difficult to effectively implement a tiered healthcare system, NHI resources would continue to be wasted, healthcare workers would remain overburdened, and issues of overcrowding in emergency departments and the impending collapse of the medical system would remain impossible to resolve.
Lin Yung-zen is the director of the Taiwan Primary Care Association.
Translated by Kyra Gustavsen
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