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Lunch with DOSI Director-General Donald Shang

The ECCT's Pharmaceutical, Medical Device and Healthcare Enhancement jointly hosted a lunch on the topic "Towards a holistic healthcare system" featuring guest speaker Dr Donald Shang (Tung-fu), Director-General of the Department of Social Insurance (DOSI), Ministry of Health & Welfare (MOHW). At the event the speaker gave an overview of the progress made to date and the challenges yet to overcome towards creating a holistic healthcare system in Taiwan.

Dr Shang began by highlighting the impact of Taiwan's rapidly-aging society. Taiwan is already classified as an aging society with over-65s already accounting for over 13% of the population, a percentage which has doubled since 1993. Based on current trends, this percentage will reach 14.5% in 2018, making Taiwan and "aged" society. If the trend continues, by 2026, the percentage will reach 20.6%, making Taiwan a "super-aged" society. This trend highlights the urgent need for long term care (LTC), which is currently one of main focuses of healthcare authorities.

Taiwan's healthcare system underwent a major restructuring in 2013 when the previously separate health and social welfare agencies were combined into the Ministry of Health and Welfare (MOHW).
Under the MOHW, the Department of Social Insurance (DOSI) is responsible for managing the national pension system, national health insurance and the LTC programme, currently being planned. It also supervises the execution of affairs regarding social insurance.

The department is divided into seven sections: The Department of Planning, Department of Social Assistance and Social Work, Department of Protective Services, Department of Nursing and Healthcare, Department of Medical Affairs, Department of Mental and Oral Health and the Department of Chinese Medicine and Pharmacy.

DOSI is responsible for planning and promoting national pension policy, as well as supervising its operation, drafting relevant laws and regulations; planning and promoting national health insurance, as well as supervising the operation of the National Health Insurance Administration (NHIA, which has six divisions and 21 liaison offices), drafting relevant laws and regulations; drafting the scope of the NHIA budget for medical care, its policy objectives, planning the LTC insurance system and drafting relevant laws and regulations in this regard.

The overarching objectives of Taiwan's healthcare authorities follow the spirit of the World Health Organisation's definition of health which it defines as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

Building a holistic healthcare system requires three stages: The first stage is to set up a national healthcare system, which includes an insurance system that utilises electronic medical records and a health bank to secure the quality and efficiency of medical care. The second stage involves providing comprehensive post-acute care for patients' recovery and the last stage is long-term care.

Taiwan has already made great progress towards creating a holistic healthcare system. A national health insurance system has been in place since 1995. The system provides universal coverage. The so-called 2nd generation NHI reforms were introduced in 2013 in order to address financial imbalances, the lack of a check and balance mechanism, the fact that premiums were based only on monthly payroll and the need for further improvements in controlling expenditures. Besides addressing financial concerns, the reforms of 2013 also improved transparency in the form of disclosure of meeting proceedings and possible conflicts of interest of the participants, disclosure of financial data of the contracted providers with medical claims exceeding a certain amount, disclosure of information on the quality of care and disclosure of serious rule violators.

The system consistently receives high public approval rates given its universal access, affordability and quality. It helps disadvantaged groups and takes care of the most vulnerable patients. According to statistics cited by Shang, patients with catastrophic diseases represent 3.94% of the population but accounted for 27.58% of NHI medical expenditures.

Shang went on to introduce new innovations such as My Health Bank and the NHI Pharma Cloud and other efforts to modernise healthcare services. The Pharma Cloud records patients' drug utilization data of the last three months, making available real-time searches for hospitals and physicians to avoid duplicate drug dispensing and to guarantee drug safety and quality. The aim of My Health Bank is to give both patients and medical professionals easy access to medical history and related data in order to better monitor and manage the health of patients.

Taiwan has made progress in providing post-acute care (PAC), for example for stroke patients and burn victims (from the notorious water park explosion incident in 2015). According to Shang, of the 1,000 stroke patients, 87% of them showed improvement post PAC and 81% of patients returned to homecare or outpatient rehabilitation.

In terms of Long-term Care (LTC), authorities are working on creating an LTC network (including home care, community care and institutional care), workforce development (care providers and others), legislation and preventative care. A second 10-year LTC programme is being launched this year in line with its objective of creating an affordable, high quality, universal LTC system.

Shang concluded that based on key measures such as infant mortality rates, which are lower than many OECD countries, and life expectancy, which is equivalent to the OECD average, Taiwan has made great progress. The next step towards creating a truly holistic system is integrating the current healthcare and the new LTC system.