Poppy recently asked Steve to write about the National Health Service of Taiwan. Here are his thoughts.
Our national health service (NHS) has been carried out since about 15 years ago. It benefits quite a lot of people, in particular those with relatively lower social economic status. However, we medical professionals see many problems and disadvantages of this system. Medical doctors contend with this system hardly, some even tend to withdrawal from this system.
First of all, people never cherish our medical resources. About 15% patients do “doctor shopping”, have a lot of medicine home but do not really take them. Some patients even visit doctors more than 30 times in one year.
Second, we do not have a well established referral system. People can make an appointment with any medical doctor in medical center and do not need to go to their GP first. People make an appointment by phone or online booking in their own and come with non-specific complaints. For instance, I am a neurosurgeon in medical center and I have a lot of first-visited patients coming with headache. They book neurosurgeon clinic by themselves based on their simple thought in that headache indicates brain tumor. Because of the lack of GP referral system, I always have >50 patients in one clinic, 10 of them are first-visited. This increases my working hours and reduces the time for examining every individual patient, which means the medical quality might be compromised.
Those above-mentioned phenomenon forms vicious cycle. People wastes medical resources, and then NHS gets financial problems. However, our politicians just care about their votes. They neither raise the insurance fee nor reduce the NHS-covered medical treatments. For the financial shortage, they reduce the payments for hospital and then the hospital employs less medical staffs. Every medical staff is asked to finish the work without enough man power. Could you imagine that the payment which NHS gives for brain tumor surgery is less than that patients pay for implantation of a tooth at their own expense? Could you imagine that a nurse needs to be responsible for nursing care of maximal 18 patients? These make our medical quality more and more worse and discourage all medical doctors and nurses from devoting themselves to their favorite work.
Currently in Taiwan, most of medical doctors are very disappointed with this torturous system and the system is collapsing.