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Talk of the Day -- Taiwan debates 'covering major illnesses only'

2012/07/22 20:31:12

A leading figure in the medical profession on Saturday proposed a national referendum on changing the National Health Insurance (NHI) program so it would only cover major illnesses.

As the ballooning deficit of the NHI continued to grip the nation, Koo Foundation Sun Yat-sen Cancer Center's Vice Superintendent Hsieh Yen-yau made the proposal in response to Premier Sean Chen, who has touted the idea of asking patients to pay the bills for minor illnesses as a means to save money for the beloved but abused health insurance system.

During a medical summit on protecting Taiwan's medical insurance system, Hsieh also lambasted "quite a number of " medical doctors who schedule excessive surgeries to increase their own incomes by bilking the medical insurance program.

"These doctors could be seen as defrauding the system and should go to jail," Hsieh said.

Below are excerpts of reports on the debate by major Taiwanese newspapers:

The United Daily News:

Hsieh told the media after the summit held by the Department of Health that even a rich country like the United States has not dared to implement a national health insurance program that covers every citizen for nearly all types of sicknesses.

In Taiwan, where the coverage is offered, the citizens make an average of 15 visits to hospitals per year. There is no more room to increase diagnosis and surgery fees for medical doctors before the system goes broke, he said.

"The medical professionals must reflect on themselves, rather than blame the public for making too many hospital visits," Hsieh said.

He cited, for example, that some doctors, eyeing diagnosis fees, are scheduling diabetes and high blood pressure patients for return visits every month, though such patients need only make a return visit every three months.

He went on to accuse some surgeons of performing excessive bypass or stent operations on patients, while ignoring the real care of these patients simply to fatten their own pockets.

"What these guys are doing is tantamount to defrauding the NHI and they really should go to jail," Hsieh said.

Since doctors may never be satisfied with their incomes, Hsieh said covered patients should pay for some of their diagnosis fees, in which case they will cut down on their visits to doctors.

As a result, he noted, physicians would have more time to discuss health problems with patients, including seeking the best solutions to their problems.

He therefore suggested that Taiwan hold a referendum on whether to adopt a system of covering only major illnesses, with patients required to pay the bills for treating their minor illnesses.

But Professor Chiang Tung-liang of National Taiwan University's Institute of Health Policy and Management said it is not always easy to tell the difference between major and minor illnesses.

Chiang said his own study finds that the national medical resources used by families in the bottom 20 percent income group have not increased, an indication that it is wealthy people who have used up a large portion of the resources -- the main reason behind the NHI's increasing expenditure and financial shortfall.

Chairperson Huang Shu-ying of Taiwan Women's Link, an advocacy group for women's rights, agreed, saying that in spite of the convenience of seeing a doctor, members of poor families are still making fewer visits to clinics and hospitals than those of well-to-do families.

"Poor people can't even afford the transportation fees. If the NHI pays only for major illnesses, they will make even fewer visits to hospitals. And I'm afraid women will be the first to fall victim to such a system," Huang said.

In addition to the economic gap, Tsai Shu-ling, a medical administration official, pointed to another gap between rich and poor in terms of access to NHI coverage -- that of educational and medical information.

"If they delay seeking medical attention for minor illnesses, they might end up suffering from major illnesses," Tsai said. (July 22, 2012)

The China Times:

Hsieh Yen-yau of the Koo Foundation Sun Yat-sen Cancer Center said under the current system there are doctors who try to see more than 100 patients in a four-hour shift. "Under such circumstances, raising fees for their services will only waste public resources," he said.

Chu Yi-hung, a medical ombudsman, disagrees. The chairman of the auditing board of the Taiwan Hospital Association said the real issue is why so many medical practitioners are quitting traditional practices and turning to plastic surgery, which is not covered by the NHI.

"If the environment is not improved for them, they will not only opt to work in the plastic surgery clinics, but will even opt to work abroad. In both cases, it is the people whose health care is most affected," Chu said.

If the government should decide to cover only major illnesses, he suggested that medical bills of poor families could be subsidized by the social welfare budget.

Further, Huang Shu-ying of the Taiwan Women's Link said if people have to pay for curing colds, not just lower-income people but also those whose monthly income is below NT$40,000 would try not to see doctors -- so they might save money.

Huang was also worried that if free market principles governs payments for treating minor illnesses, then some doctors may demand exorbitant prices for minor services. (July 22, 2012)

(By S.C. Chang)