FEATURE/What's behind Taiwan's 'unprecedented' ER overcrowding crisis?

By Sunny Lai, CNA staff reporter

[Editor's Note: This is part one of a two-part series examining Taiwan's recent ER overcrowding crisis.]

Taiwan has long prided itself on its health care system, but a surge in overcrowding in emergency rooms (ER) at medical centers around Taiwan since late January has exposed serious shortcomings that could endanger patients' lives.

CNA spoke with ER medical staff and a health policy expert to examine what exactly happened and the challenges Taiwan's ER system faces.

How serious a crisis?

During this year's nine-day Lunar New Year holiday, when most outpatient services were suspended, ER overcrowding at medical centers -- the top tier in Taiwan's three-tier hospital classification system -- worsened and persisted even after the holiday.

At a news conference on Feb. 24, Health Minister Chiu Tai-yuan (邱泰源) attributed the sudden surge in patients to outbreaks of influenza-like illnesses and norovirus caused in part by an unusually sustained period of cold weather, while a continued nursing shortage reduced inpatient ward capacity.

That was after the Taiwan Society of Emergency Medicine (TSEM) said two days earlier that ER overcrowding in Taiwan had reached an "unprecedented" level.

At its core, the crisis manifested itself in ER patients waiting for inpatient ward beds, forcing critically ill patients to remain in the ER, the TSEM said.

There were also too many people crowded into medical center ERs who could have been cared for at lower-tier hospitals or clinics, Deputy Health Minister Lin Ching-yi (林靜儀) said at the same news conference.

"I feel like every day now is like dealing with a mass casualty situation," Chen Liang-fu (陳亮甫), an attending physician in emergency medicine at a Taipei medical center, told CNA in a recent interview.

Breaking down the numbers

Certainly, just the huge surge in patients before, during, and after the Lunar New Year holiday in 2025 was bound to test medical center ER resources.

According to figures provided by Liu Yu-ching (劉玉菁), deputy head of the Ministry of Health and Welfare's (MOHW) Department of Medical Affairs, there was an average of 37,478 daily visits to ERs in hospitals across Taiwan during the holiday period (from two days before New Year's Eve to the fifth day of the festival).

That was up 31 percent to 81 percent from averages ranging from 20,744 to 28,530 visits over the previous four years, and it exposed the general lack of beds at medical centers.

No place to put patients

Chen said that since the second half of 2024, the waiting time for hospital admission for ER patients has been three to five times longer than before.

In the past, when doctors decided in the morning that a patient needed to be admitted, they could usually be transferred to a ward and assigned a bed by the afternoon, Chen said.

"But now, the process takes around three to five days," he said, with the longest wait time he had encountered being seven days.

The 32-year-old doctor said in cases where patients need treatment in an intensive care unit, some have been unable to get the necessary care due to prolonged stays in the ER, as ward beds needed for post-treatment care were unavailable.

"Their treatment is affected because they are unable to undergo surgery or be admitted to the ICU," he said.

Nursing Shortage

Lee Wui-chiang (李偉強), vice superintendent of the Taipei Veterans General Hospital, echoed Health Minister Chiu in identifying shrinking nursing staffs at hospitals as another root cause of ER overcrowding.

"Multiple factors have come together to create a perfect storm," according to Lee.

Part of the problem is that many nurses have opted for less demanding roles in clinics and home care, Lee said.

"In those settings, the workload is lighter compared to large hospitals [referring to medical centers], and salaries are not necessarily lower," said Lee, who is also an adjunct professor at National Yang Ming Chiao Tung University's Institute of Hospital and Health Care Administration.

With fewer nurses willing to work in the more intense environments of hospitals, medical centers have had trouble complying with the new, higher nurse-to-patient ratios set by the government in March 2024.

That has resulted in hospitals shutting down beds to avoid penalties, such as downgrades in MOHW accreditation, Lee said.

According to the MOHW, the nurse-to-patient ratios at medical centers are set at 1:6 for day shifts (8 a.m. to 4 p.m.), 1:9 for night shifts (4 p.m. to midnight), and 1:11 for overnight shifts (midnight to 8 a.m.).

Yet, from November 2024 to January 2025, the overall compliance rates with the required ratio ranged from 37 to 59 percent across the 23 medical centers in Taiwan, Liu Yueh-ping (劉越萍), head of the MOHW's Department of Medical Affairs, said at the Feb. 24 news conference.

A failed tiered system?

The overcrowding has also exposed the failure of the government's hospital tier system.

In medical center ERs that have experienced surges, only around 30 percent of ER cases were level 1 and level 2 emergencies needing immediate or quick intervention, said Deputy Health Minister Lin at the same news conference.

Asked why many Taiwanese tend to seek treatment in ERs at medical centers despite long waiting times, Lee cited a lack of public trust in the quality of care at both regional hospitals, the second tier in the classification system, and third-tier district hospitals.

"If a patient happens to have a serious condition, small hospitals [referring to district hospitals] often lack the capability to handle it," Lee said.

In addition, many district hospitals lack the necessary equipment to accurately determine whether a patient's condition is serious or not, Lee said.

As a result, if there are any signs of complexity, district hospitals often refer patients directly to medical centers to avoid potential medical disputes, he added.

If people do not use medical resources wisely and continue seeking care at medical centers for minor ailments, "everyone will suffer together in the end," Lee warned.

Are there answers?

Having served as an ER doctor for six years, Chen called for a more transparent system that provides real-time information on different hospitals' capacities or dedicated personnel to coordinate patient transfers between hospitals.

"I have no idea whether other hospitals have available beds [in certain departments' wards]" he said, stressing the need for such information during times of overcrowding.

On the issue of nurses, Kao Ching-chiu (高靖秋), then-convener of the board of directors at the Taiwan Union of Nurses Association, suggested in late February that a government-funded monthly additional allowance of NT$10,000 (US$302) for hospital nurses performing clinical duties, to be provided until the nursing workforce recovers.

Another suggestion was to increase inpatient nursing fees for patients admitted through the ER and requiring a hospital bed, Kao said at the time, adding that such adjustments would also better reflect the professional value of nursing.

Meanwhile, on the general overcrowding problem, Lee said that while Taiwanese have the freedom to seek treatment in ERs at medical centers, they must adjust their care-seeking habits based on the lessons learned from the crisis.

With data showing that ERs at regional and district hospitals are not overcrowded, Lee said the public should recognize the importance of seeking treatment for minor health issues at institutions other than medical centers.

"Going there first might actually get you treated faster," Lee said.

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