Healthcare system panel discussion
The panelists were Huang San-kuei, Director-General, National Health Insurance Administration (NHIA); Chu Tung-Kuang, Director-General, Department of Social Insurance (DoSI), Ministry of Health and Welfare (MoHW); Chou Li-Fang, Deputy Mayor, Taipei City; Liu Li-Ling, Chief Delegate, Taiwan Food and Drug Administration (TFDA); Lee Long-Teng, Chief Doctor, National Taiwan University Hospital; Cheng Shou-Hsia, Directorial Professor, National Taiwan University; Irene Feng, ECCT Healthcare Enhancement Committee Co-Chair and Linda Sheng, ECCT Pharmaceutical Committee Co-Chair.
Yang began with a summary of a survey conducted in March 2015 by Global Views of 8,733 medical professionals including doctors, nurses, pharmacists and executive managers of hospitals and clinics.
According to Yang, there are five major crises facing Taiwan: 1) An over-emphasis on defensive medical treatment; 2) Too many unwanted patients; 3) A critical lack of effective medicine; 4) Poor quality medical devices and 5) No one wants to take care of critically ill patients.
According to the survey, 92% of medical professionals are pessimistic about the future of Taiwan's healthcare system. More than 60% of them believe that the quality of treatment, medicine and medical devices has deteriorated while 59.4% of respondents think that patients and their families do not respect medical professionals.
75.4% of staff are dissatisfied with their current work environments. This is partly a result of overwork. 67% of doctors work overtime (more than 50 hours per week. Surgeons and gynaecologists work even longer hours). Because of a shortage of medical staff, 40% of medical professionals say they sometimes make mistakes. Given a stressful work environment, 66% of nurses are thinking about working abroad in places like the United States or Singapore (although not many have actually acted on this yet).
52.1% of doctors will choose defensive treatment rather than aggressive treatment in order to avoid disputes with patients or their families. 68% of professionals believe that the most effective way to avoid abuse in the system is to increase the amount that patients have to pay for treatment.
In summary, Yang said that that there are three main problems in the system: an uneven distribution of medical resources, abuse of the system and unreasonable pricing of medical products and services. To tackle the problems and create a healthy and sustainable system, the major stakeholders have to work together: government, medical professionals, industry and patients.
In the panel discussion that followed, representatives from government agencies made the point that while the general public and healthcare professionals are characteristically critical of the system and pessimistic about the future, this may be because expectations are unrealistically high. One official said that there is no such thing as a perfect healthcare system and, for the price paid, Taiwan's system is comparatively comprehensive and efficient by global standards. Moreover, while the NHIA system was under serious strain in 2010, following the modest increase in insurance premiums, the financial situation has been brought under control. However, given Taiwan's aging population and consequent expected rise in costs, there is still a question as to the future financial sustainability of the system.
According to figures quoted by officials Taiwan's annual healthcare spending of NT$600 billion, is equivalent to 33-34% of the total national budget and more than the combined budgets of the Ministry of Transportation and Communications and the Ministry of Defense. Given the proportionately high spending it is difficult to justify even more spending. Instead officials believe the main focus should be on making better use of resources available by improving efficiency, reducing waste and abuse.
Because healthcare is so cheap in Taiwan, certain patients tend to abuse the system. The authorities are working on closing loopholes to abuse. The government is also working on a cloud-based system for patient records. The aim is to put all health-related information into the same system. This will serve a number of purposes. Firstly it will place all patients' records in one place, accessible to all health agencies. This will also allow patients to get easy access to their own information. Patients will able to use their IC cards to download their medical records including statistics and what medicines they have taken.
This will benefit patients as well as hospitals. By being able to check what medicines a patient has been prescribed at one hospital will enable other hospitals to stop patients from abusing the system by getting double or multiple doses of the same drugs at different hospitals.
Another benefit is that it will allow hospitals to review the behaviour of their peers. Since hospitals profit from prescribing medicines, if records are made available to their competitors, they will be able to see cases where too many drugs have been prescribed and report abuses. Since July this year, the government has been using the system to crack down on the practice of deliberately prescribing too many drugs. According to statistics quoted by one of the panelists, the system has already resulted in NT$5.6 billion in savings for the healthcare system.
As for the solutions for Taiwan, besides cracking down on abuse, education is important. The government has to do its part but patients also have to take responsibility for their own health and reduce the burden on the system. Patients should be encouraged to use clinics for minor ailments so that pressure can be taken off hospitals to treat real emergencies and serious conditions. For hypochondriacs (the practice of hospital shopping is common in Taiwan), patients should be given counseling rather than medicine.