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Taiwan: ‘National Health Insurance’ System in Crisis

Taiwan's National Health Insurance is often used as a ‘model for reform’ in countries such as the United States where health care depends on a private insurance system. A recent article written by Princeton professor Uwe Reinhardt in the New York Times blog also praises the efficiency of the Taiwanese system.

Yet, the inconvenient truth unknown to the outside world is that such efficiency is built upon exploitation of medical staff.

Professor Reinhardt's article was written after the 2012 Europe-Taiwan Health Dialogue held in Taipei in July. He was impressed by a presentation by the Director of the Medical Informatics Center at the Department of Health in Taiwan, who talked about the efficiency of the national health care data system which monitors infectious disease.

Even though Reinhardt acknowledged the fact that Taiwan's health care is underfunded with only 6.7 percent of its gross domestic product going to health care, compared with close to 18 percent being spent in the United States, he is unaware that this low budget is at the expense of medical staff in Taiwan.

The profile picture of TMAL in Facebook

The Taiwan Medical Alliance for Labour Justice and Patient Safety (TMAL) [zh] posted a table comparing the cost of some common medical procedures on their Facebook Page. It shows that in the U.S. 25-350 times higher is charged than what is charged in Taiwan for the same procedure. The Alliance explained:

健保太便宜,還能支撐的理由就是極端地壓榨醫護和砍削藥價了。

National Health Insurance is way too cheap. The only way it can survive is oppressing the medical staff and reducing the price of medication to an extreme.

Medical staff protest against the phenomena of death from overwork. Photo from TAML's Facebook Photo Album.

TMAL further elaborated [zh] by quoting a comment made by Professor Jung-Der Wang from the Department of Public Health at the National Cheng Kung University on their Facebook page:

台灣的醫療,部分是犧牲了醫護人員的薪資與生活品質,達到降低醫療成本的效果。因健保壓低醫療照護花費,限制了醫院的營收,造成醫護人員薪資低、工時長,而有「血汗醫院」或「過勞死」之事發生。

Medical expenses are reduced partially by sacrificing the salary and quality of life of medical staff. Because National Health Insurance reduces the payment for medical care, hospitals do not earn enough money. Therefore, the salary of medical personnel is low, while their working hours are very long. This is why we call these hospitals sweatshops and why we see some death from overwork cases in this demographic.

In addition to the high risk of sickness due to overwork, medical doctors in Taiwan face high volumes of medical malpractice lawsuits. Decode-medicine [zh], an online journal on Taiwan medical profession, highlighted the astonishing statistic concerning the prosecution and conviction rate of doctors in Taiwan:

台灣自2000年起,醫療糾紛鑑定案件平均每天超過一件…其中有八成是刑事訴訟案件。平均每10.5天就有一位醫師因刑事案件被起訴。平均每38.8天就有一位醫師因刑事案件被定罪。台灣醫師的「有罪率」世界第一,竟高達四分之一(25.6%)。

Since 2000, there has been more than one lawsuit for medical malpractice per day in Taiwan…80% of them are criminal suits. On average, one medical doctor is prosecuted in a criminal lawsuit every 10.5 days. On average, one medical doctor is declared as guilty in these criminal suits every 38.8 days. The “conviction rate” of medical doctors in Taiwan is 25.6%, the highest in the world.

The increasing number of lawsuits against medical doctors, along with long working hour and low salary, discourages young physicians from joining the five major medical departments [zh], including Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, and Emergency.

TMAL summarized [zh] the crisis of the National Health Insurance system in Taiwan:

台灣的全民健保制度就像似在蓋一棟沒有地基的高樓,當初規劃的時候並沒有打好地基〔沒有保障勞動工時、給付沒有考量醫療風險、也沒有規劃醫療糾紛相關保險等等〕,樓層就一層一層往上蓋,如今,高樓已經開始搖搖欲墜了!

National Health Insurance in Taiwan is run like a tall building without a proper foundation. When we made the plan for  national health insurance, we did not build a good foundation for it. (We did not guarantee reasonable working hours, we did not consider the risk of medical procedures, and we did not plan for an insurance system related to medical disputes.) This building has been built taller and taller, and this tall building is now shaking and falling apart!

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