There was a story in the Typo Times the other day (sorry I don’t have the link) about how Veterans General Hospital in Taichung had been turning away seriously ill patients because it would cost too much to treat them. So the NHS decided to “punish” the hospital by cutting their funding even more (which of course means they’ll have to turn away even more patients).
The article was very shallow - the reporter didn’t bother to interview the directors of the hospital and apparently got all his biased info from NHS. The hospital does indeed have a story to tell.
I happen to be good friends with a local doctor here in Taitung, and he tells me that ALL the hospitals are in serious financial trouble. Basically, NHS is going broke, and their solution is to cut funding to the hospitals to about 80% of what is actually needed for the hospitals to break even. Unfortunately for the hospitals, the fees they charge are set by NHS, so they can’t simply raise fees by 20% to make up for the loss. So they are turning away patients. The only other option they have is to close their doors.
The patients who get turned away are NOT the ones who should be turned away (ie the hypochondriacs who show up every week for their NT$100 bag of sugar pills). Rather, they are turning away patients who need expensive surgery and other expensive care.
With the legislative elections coming up in December, NHS won’t dare to raise fees this year. They might next year, but expect a major public outcry. Anyone here who really does need surgery might consider going to Thailand or Singapore, which are making quite a business out of “medical tourism”. By the way, that might include me.
This is actually something well known in the medical field.
At the current spend rate, and despite the implementation of a Canadian style global budget caps, the NHIB is estimated to go bust by next year. The NHIB has also restricted the number of outpatients that a given hospital can service in a quarter. Taiwan has one of the worst ratios of outpatient vs. impatient in the world Additionally, all hospitals are only getting about 0.9 TWD for every reimbursable dollar they spend.
As soon as the necessary measure of turning away the sugar pill day-trippers from hospitals is begun there will be a public outcry. Expect media outrage and pictures of Mrs. Wang crying on TV because she can’t get her flu jab, while her husband protests noisily about his “human rights” being violated.
The turning away has actually already begun, just in a very quiet way. Notice how outpatient hours have shrunk? Or how certain dept’s have closed near the end of the quarter? It’s not very noticeable now, but it will be. Some hospitals have racked up some big losses this quarter due to seeing to many patients
What is happening is completely predictable. I can’t believe anybody is surprised! But, of course, you’re right Mr and Mrs Wang will be squealing loudly about their ‘human right’ to while away their retirement in the outpatients’ departments being violated.
In the UK people always used to complain about NHS managers soaking up funds that should be given to ‘medical care’ but here you have National Health Insurance but no National Health Service. A little bit of management wouldn’t go amiss here.
There are few family doctors and nobody in the whole system whose job it is to keep patients healthy and who gets a capitation fee for doing so rather than a fee for seeing patients.
If I do have a problem then what to do isn’t easy to decide: If I have a headache I can self-refer to the top brain surgeon in the country (if I do a bit of research and find out who he or she is)! And if I don’t like what I hear, I can make an appointment to see the number two… and so on.
I feel unwell and go to the hospital… how do I decide who to see? I have to guess! Or I accept the advice of an untrained receptionist who asks me ‘nali bushufu?’ It’s absolute madness as a way to run a health system.
Economists have long recognised the ‘problem of the commons’ where free (or minimal cost) resources are destroyed by the manner in which they are used. That’s a danger in any society but I dare to say that culturally Chinese are better than most at doing this! (Am I being unfair?)
And yes, everybody can see there are more than a few (mostly elderly) people who go to hospital here as a hobby.
I think the problem of self-diagnosing in order to know which hospital department to go to wouldn’t be solved by GPs (seeing patients first and then referring if needed) for the simple reason that many GPs don’t have much of a clue beyond common colds.
A couple of months ago I had a very mild eye infection so I went to the local hospital to get some drops. It’s just down the road so it’s actually more convenient than going to a clinic. I figured I’d see an eye doctor but it was Saturday and that dept had shut up shop earlier. Could I see a GP instead? The receptionist says no. After much pleading and protesting I was eventually allowed to see a GP. The GP was extremely hesitant. She said I probably had an eye infection but wanted to refer me to an eye doc. Then she wasn’t sure what medication to give me. I was not impressed.
One thing they could do to lower the cost of healthcare is breastfeed their babies for more than a month! Fewer illnesses, faster recovery, lowered risk of breast cancer for the mothers and probably loads of other benefits.