When he took over the presidency of the National Health Insurance Bureau four years ago, Chang Hong-jen (張鴻仁) appeared the model of technocratic accomplishment and confidence as he vowed to ensure the right of every Taiwanese to medical care. \nNow his reputation is in tatters and his is considering whether to step down from his most recent appointment as deputy director-general of the Department of Health (DOH) to take responsibility for the debacle surrounding the bureau's fixed budget policy. \nHandpicked by Lee Ming-liang (李明亮), the then director-general of the DOH, Chang took up the post when the bureau suffered its first financial hemorrhage. Within five months in his new position, Chang found himself facing a crisis. In December 2001, the bureau's safety reserve dropped to an unprecedented low, less than a month's need. The doctor-turned-administrator's mission was to get the anemic bureau back on its feet. \nDuring his tenure at the bureau from 2000 until this year, Chang pushed ahead with the fixed budget policy. At news briefings, Chang could reel off the miscellaneous items on the bureau's financial statement and detail the different contribution made by different insurance ratios or premium hikes. When bean counters and academics were racking their brains to tighten the bureau's expenses, Chang told his subordinates, "the solution is simply this -- we need to hew out a new path and find new resources." \nAs he told his subordinates to find more money, Chang enforced the double health insurance hikes in 2002 with toughness. Amid the Control Yuan's reprimands and fierce attacks from the opposition parties, Lee stepped down. Chang, the mastermind behind the scheme, rode out the political storm safe and sound. \nSurviving the fallout, the Teflon official was further emboldened to implement the fixed budget policy. Sleek and suave, Chang hides his steel over reform behind a smiling face. To bring hospitals to the negotiation table with the government, the Harvard-educated Chang negotiated with different interest groups and convened hundreds of meetings with hospitals nationwide to put the "Hospital Excellence Plan" into practice. \nHis competence had won him the appreciation and trust of his bosses. Over the past 15 years, Chang has climbed the bureaucratic ladder rapidly and steadily. From director of the DOH's Bureau of Disease Prevention, to the vice president of the Bureau of National Health Insurance, and then on to become director of the Center for Disease Control, Chang excelled in various administrative fields. No one in the current medical administration has ever served in as many posts as Chang. Not surprisingly, he become the most trusted aide to the country's highest health official, the DOH director, be it Chan Chi-Shean (詹啟賢) during Chinese Nationalist Party rule, or Lee Ming-liang (李明亮) and Chen Chien-jen (陳建仁) from the current Democratic Progressive Party government. \nWhen SARS hit the nation last year, Lee appointed Chang to coordinate and facilitate medical resources among quarantined hospitals. Chang's handling of this won the praise of Premier Yu Shyi-kun. \nBut despite his stellar record, the community hospitals' protest against him is not the first time he has been in trouble. He quit his job as director of the Bureau of Disease Prevention due to the alleged spread of the bacterium vibrio cholerae in 1997. A veteran of the medical bureaucracy, Chang knows well how to play the game. \nLast week's demonstration by 1,700 health workers from community hospitals did not ruffle Chang's sang froid. On learning that he would be the principle target of the demonstration he said "isn't this too big an honor for me?" \nChang will announce his decision today. But even if he decides to go, this will not solve the problems of the nation's health insurance program. His boss, Chen Chien-jen, has urged him to stay, saying "we cannot scapegoat an individual for institutional wrongs."
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