A decade after carving out the widely hailed "Health Utopia" for Taiwanese citizens, the Bureau of National Health Insurance now finds itself walking a tightrope between fuming patients and uncooperative hospitals.
Since the bureau launched the fixed budget plan for each hospital in July, patients have reportedly been turned down by a number of hospitals. According to figures from the bureau's central Taiwan branch alone, 62 patients filed complaints over being unable to register at hospitals in the first two weeks of this month, four of whom suffered from rare or severe diseases. The number of complaints was three times higher than usual.
Since July, hospitals allegedly have limited the number of outpatients they treat to save money. Many have laid down quotas for each doctor, specifying how many patients can be seen each day and limiting what medicine can be prescribed.
Unfortunately, it is the patients who need hospitals the most who get shunted away. Patients with cancer, psychiatric illnesses or rare diseases who require long-term care and pricey medicine are the first victims of the cut in access.
According to the Taiwan Hospital Association's statistics, patients with cancer account for 43 percent of total medical spending while patients with psychiatric illnesses made up 21 percent.
"It's not hard to tell who suffers most from a tightfisted government and its rash policy," said the association's chief executive Wu Ming-yen (
Hemophiliacs have also born the brunt of the access cut. The nation's biggest supplier of plasma products for hemophiliacs, National Taiwan University Hospital, has overspent by NT$80 million for the past two months. Last week, the hospital restricted hemophiliacs to one blood concentrate treatment at hospital and one at home. Hemophiliacs used to get one injection at hospital and take three home with them.
"The limit could cost some lives if it's allowed to last," said Shan Ming-jing (
According to hospital representatives, the fixed-budget policy is well-intended yet not well thought out. "We realize that the bureau is destitute and people are unwilling to pay more," said Wu.
"Yet the bureau could discuss how to divide the small sum of money with the hospitals. It is not fair for the hospitals to absorb the bureau's annual NT$20 billion deficit. A simple cut on the hospitals' part does more harm than good," he said.
The bureau spends about NT$360 billion every year and allotted NT$260 billion to hospitals last year. Although the bureau will give hospitals a 3.53 percent budget boost for 2005, the hospitals contend that this is totally insufficient.
The association's statistics show that medical expenses for the elderly grow at a staggering 14 percent every year as a result of an ageing population and advancements in medical technology. However, the insurance rate has been pegged -- at 4.55 percent of earnings -- since 2002.
"Any fee raise will ruffle the public's feathers," said Deng Shih-hui (
"With the year-end legislative election, no politician dares to propose a premium hike and risk enraging voters," Deng said.
Not surprisingly, the bureau is again in a financial quagmire. By the end of this year, the bureau's NT$10.5 billion safety reserve will have fallen to NT$ 300 million, less than a day's insurance costs.
Aside from the fixed budgets for hospitals, bureau officials have been racking their brains to formulate other means to reduce spending and increase revenue.
The bureau's president, Liu Chien-hsiang (
These plans include a 5.08 percent insurance rate to fill the bureau's coffer for the next five years, a 4.97 percent insurance rate to suffice the bureau for two years and a higher base rate for public servants.
In response to the patients whose lives maybe in crisis due to limited medical access, Liu vowed to stamp out such practices.
"We monitor patients with rare and severe diseases through their personal IC health cards and send inspectors to hospitals regularly," Liu said. "If any hospitals are found turning down patients, we will cancel their right to contract with us.
"Care for the minority has always been the core value of the universal health insurance plan."
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