Long story short… I love and hate the medical coverage here in Taiwan.
Love that its very affordable, hate the fact that the doctors really dont pinpoint the problem and resolve it…
if your condition sounds anything remotely like the other 30 people he has already seen today… you are just a number…" whats the problem?"… "hmm, sounds like you got what everyone else has because WINTER is here… "
winter… 76 degrees is winter here?
They carpet bomb the area with a cocktail of meds that “should” work… and only enough meds for 3 days. I dont know of any antibiotic that will kill off something in 3 days time.
My last doctor gave me the following mix of meds to combat my sorethroat, I did not have fever: Codeine, Tagamet ( antacid medicine), some kind of anti depressant behavior pill ( forgot the name but I look up every pill before I take it), and an antibiotic pill that was not the one that I requested - asked for Zithromax and they gave me something different, and two other pills to “open up my airway”. And three other meds I dont remember right now.
The doctor never physically touched my throat or neck area… Why the hell not? Am I going to bite him? How the fuck do you diagnose people by just asking questions.
I complained on the 3rd day…that now my throat feels like its burning, and my stomach is now making backflips at night. “Oh that just must be a side-effect”… heres your next 3 day supply of meds.
Ended up with my stomach getting wrecked by all the different meds… losing 4 kilos of weight, and I clearly told them… I have no appetite… the instructions were… “its ok you can take these meds with or without a meal.”
I needed to go to 4 doctors each giving me a terrible diagnosis. When i asked for a throat culture, they looked at me like I was speaking in tongues. Only the final doctor “got it right”… with some basic meds, and a machine that actually looked in my throat instead of the wooden stick to hold my tongue down and a flashlight. Oh and its a literal nightmare if you decide to go to WebMD and self diagnose… there are people out there in much more dire need than me, and its just horrible reading other people’s opinions and their conditions.
If anyone can suggest a method of speaking to the doctors here as clearly as possible, please let me know.
I’ve had a cold for 8 days, that won’t shift. Our neighbour doc, good friend, runs a clinic close by, so I went to him. Explained my illness clearly - result, same 3 days of useless tablets, instead of a simple 5 day course of antibiotics. Result, I’ve now had the cold for 13 days, and will have to go back. Presumably this time I’ll get what I need.
Actually this is a very serious issue in Taiwan. I also love that docs are available on every street corner, but they have almost zero follow-up or patience when examining the patient.
I’ve had a couple of mild but chronic issues and I self diagnosed myself in two cases, the docs simply didn’t take the time to ask questions and do a history (history examination is supposed to be a core of all doc training). I even suspect they may have known the real issues sometimes but simply not cared to deal with further questions and therefore slow down their patient throughput.
The docs do tend to throw the chemical kitchen sink at everything without doing a thorough diagnosis. That harms the liver, the stomach, costs the jianbao (and taxpayers) a tonne of money , spreads antibiotic resistance and it’s not an efficient way of treating people. They need to use modern diagnostics more…they are REALLY behind the curve on that in GP offices (and that is a problem in GPs in other countries too…too reliant on guesswork).
Probably the worse trait the docs here have is not explaining their diagnosis and why they prescribe certain medications.
I must say the consultants tend to be much better in hospitals…pay more money…get a bit more time and a lot more expertise! Just go direct to the consultants for any slightly serious complaint.
[quote=“downtownandrew”]Long story short… I love and hate the medical coverage here in Taiwan.
Love that its very affordable, [/quote]
To translate your observation into numbers, your average monthly NHI premium will be around NT$ 2,000, whereas a private insurance like AIG or Allianz with full coverage and some privileges will cost you in the range of NT$ 20,000 per month. That is a factor of x10.
Now that is the entire point: why would you expect personalised service for NT$ 2,000 a month? It’s a bit like the difference between economy class and first class air fare. Both get you from A to B, yet in economy class you don’t get much attention. Your ride won’t be unsafe or unbearable either, the experience will just be a bit more “basic” and focused on the essential service: transportation.
Likewise, these 8 pills will get rid of that sore throat some way and you will get the treatment you need at the ER. Just don’t expect a single person room or fancy meals.
I am surprised that anyone would imagine to get more in a system of socialised medicine as cheap as in Taiwan. Healthcare is a service and service providers need incentives to provide more than the legal requirement. Pay more, get more. Simple.
As usual hsinhai misses the point. The OP us complaining he is getting too much not too little. It’s unecessary, wasteful and leads to greater spending in the future for the system.
The 8 pills are excessive. The op is not asking for 100 but 1 that actually works.
[quote=“Mucha Man”]As usual Xinhai misses the point. The OP us complaining he is getting too much not too little. It’s unecessary, wasteful and leads to greater spending in the future for the system.
The 8 pills are excessive. The op is not asking for 100 but 1 that actually works.[/quote]
On the contrary, Mucha Man. But thanks for the ad-hominem anyways.
The cost factor is not the drugs but time a doctor spends on each patient.
The drugs are generics and produced in Taiwan in mass scale.
A doctor gets a one-off fee for most cases. This fee is ridiculously low considering a doctor studied 5+ years and has to cover for rent, equipment, staff salary and his own margin.
The only way to be profitable is to spend only a fraction of an hour on each patient. Otherwise the effective hourly pay of a doctor would be less than that of a 7-11 clerk. (mind you, we are talking about NHI-enrolled family clinics here, not plastic surgeons or non-NHI-enrolled dentists.)
That is the flaw of the NHI but also the reason it is so cheap: 5 minutes plus 8 pills. For a total of NT$ 300 out of pocket plus another NT$ 400 co-payed by the NHI.
There IS NO CURE for colds and sore throats. These are viral infections so literally the only thing you can do is rest and wait them out.
Doctors obviously can’t say that to patients as Taiwanese people see Western medicine = pills, so they have to prescribe a ton of fake stuff + stuff they presumably get some financial kickbacks on.
The doctors usually prescribe painkillers and weak decongestants, but honestly they’re in such low doses it’s better to just buy an over the counter cold medicine, in pill form or drink, and dose yourself.
[quote=“aphasiac”]
Doctors obviously can’t say that to patients as Taiwanese people see Western medicine = pills [/quote]
That and the perceived value people get for their treatments. After all it’s a compulsory system and drowning people in pills makes them feel like they get something for their money.
I’ve had doctors explicitly tell me as much. But I do miss being able to see a doctor without breaking the bank. I’m waiting for my company to give me insurance still, so I have to wait until May before I can see someone about this really strange tongue swelling thing.
That’s why I seldom ever went to the doctor in Taiwan. If I had a sore throat/fever/cold, I just took take of it myself. I always brought meds with me from the States. The only time I went to see the doc was when I caught the flu. The flu is a b*tch, so I had to see the doctor.
[quote=“hsinhai78”][quote=“Muzha Man”]As usual Xinhai misses the point. The OP us complaining he is getting too much not too little. It’s unecessary, wasteful and leads to greater spending in the future for the system.
The 8 pills are excessive. The op is not asking for 100 but 1 that actually works.[/quote]
On the contrary, Muzha Man. But thanks for the ad-hominem anyways.
The cost factor is not the drugs but time a doctor spends on each patient.
The drugs are generics and produced in Taiwan in mass scale.
A doctor gets a one-off fee for most cases. This fee is ridiculously low considering a doctor studied 5+ years and has to cover for rent, equipment, staff salary and his own margin.
The only way to be profitable is to spend only a fraction of an hour on each patient. Otherwise the effective hourly pay of a doctor would be less than that of a 7-11 clerk. (mind you, we are talking about NHI-enrolled family clinics here, not plastic surgeons or non-NHI-enrolled dentists.)
That is the flaw of the NHI but also the reason it is so cheap: 5 minutes plus 8 pills. For a total of NT$ 300 out of pocket plus another NT$ 400 co-payed by the NHI.
Pay more, get more.[/quote]
most of the docs have an interest or deal with nearby pharmacy, they also kick backs from drug manufacturers as well. I’ve asked for a specific brand of allergy spray (and which I told him specifically had relieved my symptoms) and the doc straight out prescribed me a different brand …a local version which I didn’t want. The active ingredient was different also. I had been prescribed the foreign manufacturers version by another doctor at the same clinic…they obviously have different deals going on. he didn’t explain why he ignored my request and he had my records on his system from last visit as well. They also have a pharmacy on the premises which is illegal but somehow they get away with it. Hey cheap meds for us but they don’t always have patients best interests in mind.
One thing Taiwan takes very seriously though is management of pain drugs. In the US its a very very serious problem, much bigger than the illegal drug problem!
Drug cost is seriously controlled by NHI, mostly you get generic drugs prescribed, not the actual original manufacturer’s when the patent is expired. (many countries do that now to have a check on med care cost)
I’ve gotten several times meds for 2 months at the time when going on a visit back home, needed my plane ticket to show and they have to forward this to NHI.
But OTC drugs or not-controlled meds are given to people like M&M’s, in matching colors to your attire. Actually paracetamol is free (or cheaper) up to a certain quantity per month, even at pharmacies. They will ask your NHI card to check on that. But you can buy as much as you want when you pay for it, but remember Paracetamol is dangerous if taken too much. In Taiwan it goes under the name Scanol.
Waow. I strongly disagree about this way of thinking. If you think this way, are you ready to accept any crappy public services just because it is free or almost free as it is subsidized by the government ? I don’t think the mission of the public healthcare in Taiwan is to give the essential and basic service…
Also, I’d like to remind everyone that the cost of NHI is not only the premium: cost for the employer is quite high so when your premium is 2000 NTD, total cost is around 8000 NTD which honestly is not little. Now I disagree with the OP: it is not fair to make a general comment about taiwan medical service. I had excellent experience for my sons in ER but also very bad experience in the very same hospital (Adventist), in the very same conditions. There are good doctors and bad doctors and I think it is just like that everywhere…
I had chicken pox 3 years ago and my neighborhood Doctor Chen told me then that I had a simple cold, gave me painkillers along with pills to ‘protect the stomach’. After the appointment I went to the grocery store and many middle age housewives saw me and told me that I had chicken pox and to go home and stay there because it was contagious. So it is true, there are plenty of bad doctors out there, having a second opinion is essential.
There IS NO CURE for colds and sore throats. These are viral infections so literally the only thing you can do is rest and wait them out.
Doctors obviously can’t say that to patients as Taiwanese people see Western medicine = pills, so they have to prescribe a ton of fake stuff + stuff they presumably get some financial kickbacks on.
The doctors usually prescribe painkillers and weak decongestants, but honestly they’re in such low doses it’s better to just buy an over the counter cold medicine, in pill form or drink, and dose yourself.[/quote]
sometimes a sore throat is a bacterial infection, so they may throw a few pills at you just in case. I’ve actually debated this with docs in another country before, I asked them why they didn’t use rapid tests more, and they said they didn’t necessarily see the advantage as most colds clear up on their own and they can’t treat viruses effectively. which I thought was self justification for not using modern tools to the job more than anything… There are some tests being developed to quickly differentiate between a viral
Immune response and bacterial immune response…which I thought was a neat idea which would give broad coverage.
Yes, and most public services are crap unless they are run for profit or at least to break even. One such example is the MRT in Taipei.
The NHI on the other hand is run at a deficit. What do you expect? The same standard of service a costly private insurance such as AIG would provide for US$ 15,000 per year?
And these meagre NT$ 8,000 will not only have to cover your but the countless people who are elderly and/or sick and take out more than what they pay in or pay in much less than NT$ 8,000 per month. That is the design of socialised medicine and again explains why you should not expect much more than basic care from the NHI. Yes they do cover cancer, but trust me when I say that you’ll be able to copy with your diagnosis better if you know that a private insurance company will pay for more and better treatment.
