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Deterioration of Taiwan's Healthcare System: Warnings of Imminent Erosion in Taiwan's Healthcare System

Connecting Taiwan Globally and Globally Connecting with Taiwan

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5 min read

Rich Retirees' Refusal to Pay Taxes Threatens Health Care System's Sustainability, Leading to an Inevitable Privatization with Skyrocketing Costs

Deterioration of Taiwan's Healthcare System: Warnings of Imminent Erosion in Taiwan's Healthcare System

Article Revisited

By Mike T., free-spirited journalist

On April 26, The Lancet published a letter highlighting the imminent collapse of Taiwan's healthcare system. Critics, including the Minister of Health and Welfare, swiftly dismissed these claims due to inaccuracies in the report. However, the underlying issues, such as overworked nurses and persistent wage stagnation, remain.

The letter, despite its errors, sparked conversations about health care system inefficiencies. The authors based their claims on data from local nursing associations, revealing a distressing picture of healthcare professionals working beyond their limits, with annual attrition rates reaching an alarming 12%. Moreover, they pointed out that wage stagnation since 2000 has led to real wage declines by 18%.

Critics have done little to address these issues, painting over the cracks in the healthcare system with band-aids instead of implementing meaningful solutions. The Taiwan Union of Nurses Association reported that 300,000 nursing licenses were issued, but only 190,000 nurses were actively employed by the end of 2023. This situation has long been discussed by high-level nursing educators, yet the healthcare system continues in crisis without making meaningful changes.

A 2022 statement by the Taiwan Association of Emergency Medicine mirrors the concerns expressed in The Lancet letter. One of the implications of the nursing shortage is the closure of wards, forcing critically ill patients to remain in emergency departments, compromising the ability of emergency wards to serve the public. Thus, one crucial recommendation is an adjusted payout system to fund emergency wards and re-open wards when demand surges.

THE GLOBAL BUDGET PAYMENT SYSTEM AND ITS CRITICISM

The payout system is another contentious issue. Rigid global budget payments have been cited as a significant system problem by many, including the authors of a November 2022 Journal of the Formosan Medical Association article on the deplorable state of Taiwan's pediatric care system. This system, established in 2000, is flawed due to fixed budgets and floating point caps. As hospitals' expenditures rise, the cap adjusts downward, shrinking the per-patient payout and consequently increasing the cost burden on hospitals. This may lead to their eventual bankruptcy, all while taxes remain untouched due to the easy-to-manage budget.

It seems the healthcare system is headed for financial collapse, not an abrupt breakdown as the term "collapse" may suggest. Instead, it will gradually go bankrupt, eroding over time. The dire state of wards, curtailed services, and rampant burnout among healthcare professionals are already prevalent in the system, with no end in sight.

REVENUE GENERATORS IN THE HEALTHCARE SYSTEM

Sadly, this budgetary pressure means healthcare providers are turning into revenue generators. For instance, when I faced knee problems and struggled to walk, I consulted multiple doctors, each offering expensive treatment options. I eventually found relief through a simple dietary change, avoiding invasive procedures.

Another consequence of this system is that doctors become revenue centers, while nurses are regarded as costs. Nurses, consequently, are overworked without mercy. Additionally, caps on system use remain unknown to the public until they encounter them, such as the government only covering breast cancer treatment medication for two years.

The government treats the healthcare system similarly to Taiwan Power Co. (Taipower), Taiwan Railway Corp. (TRC), and other government programs, maintaining them in a continuous state of emergency. This tactic allows the government to fix budgets, ensure low payouts, and avoid sky-high taxes, passing the financial burden to hospitals and their employees. This approach, however, is not sustainable, as the wealthy and retired, who could help, seem uninterested in footing the bill.

CALL FOR CHANGE

Efforts to improve the system, including proposing amendments to the National Health Insurance Act, have faced opposition. However, with the healthcare system on the brink of financial ruin, changes are not only necessary but urgent. The time has come to revamp the global budget payment system to better support our healthcare providers, ensure equitable care, and maintain the stability of our healthcare system for future generations.

Mike T. shares his unique insights as a seasoned resident of Taiwan, shedding light on the past, present, and possible future of the nation.

  1. The imminent collapse of Taiwan's healthcare system has brought attention to various inefficiencies within the sector.
  2. Overworked nurses, wage stagnation, and high annual attrition rates are pressing issues in Taiwan's healthcare system.
  3. The underlying issues pointed out in the letter sparked conversations about necessary changes in the healthcare system.
  4. The Taiwan Union of Nurses Association reported a shortage of actively employed nurses, despite the issuance of a high number of nursing licenses.
  5. The closure of wards due to a nursing shortage compromises the ability of emergency wards to serve the public.
  6. An adjusted payout system to fund emergency wards is a crucial recommendation to address the nursing shortage.
  7. Rigid global budget payments have been identified as a significant problem in the healthcare system by many.
  8. The system's problem lies in fixed budgets and a floating point cap that adjusts downward when expenditures rise.
  9. The deplorable state of Taiwan's pediatric care system was highlighted in a November 2022 article.
  10. Healthcare providers are increasingly turning into revenue generators due to budgetary pressure.
  11. Doctors are being treated as revenue centers, while nurses are overworked without mercy.
  12. The public remains unaware of caps on system use until they encounter them, such as limited breast cancer treatment medication coverage.
  13. The government maintains healthcare programs in a continuous state of emergency to manage budgets and avoid high taxes.
  14. Proposed amendments to the National Health Insurance Act have faced opposition, making changes necessary and urgent.
  15. Efforts should be made to revamp the global budget payment system to better support healthcare providers.
  16. Equitable care and the stability of the healthcare system for future generations depend on these changes.
  17. The wealthy and retired, who could help, seem uninterested in footing the bill, threatening the sustainability of the healthcare system.
  18. Rich retirees' refusal to pay taxes could lead to an inevitable privatization of the healthcare system with skyrocketing costs.
  19. Chronic diseases, cancer, respiratory conditions, digestive health, eye health, hearing, mental health, and other medical conditions require our attention in the healthcare system.
  20. Fitness and exercise, including workplaces promoting wellness, play a crucial role in maintaining health and wellness.
  21. Sexual health, skin care, and therapies and treatments are integral to maintaining overall health.
  22. Proper nutrition, aging gracefully, and managing weight are essential aspects of health and wellness.
  23. Healthcare professionals, including nurses, doctors, and specialists, are vital in addressing various medical conditions and maintaining health and wellness.
  24. Autoimmune disorders, neurological disorders, cardiovascular health, and environmental science are complex healthcare challenges that require ongoing research and development.
  25. Mental health, including dealing with stress, anxiety, and depression, is crucial to our overall well-being.
  26. Mens' health, women's health, parenting, and pediatric care are priority areas that demand our attention.
  27. Lifestyle choices, including fitness, diet, and stress management, impact health and wellness.
  28. Health and wellness, medical conditions, and the healthcare industry are critical aspects of financial planning, including investing in wealth management, personal finance, and insurance, like Medicare.
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