Wang Renxian: Taiwan Health Insurance is still the best but needs improvement

Has the Taiwan health insurance system really crashed? At least from the media, yes.

Taiwan’s Health magazine published the cover article “Taiwan Medical Incident Collapse” in July. For the first time, the term “crash” was used to describe the current status of Taiwan’s health insurance; in April, Taiwan’s nurse Lin Meiqi used the “The dark moment of nurses” (in Taiwan)" submitted a manuscript to the United States CNN; in May, Hong Haoyun, the chief surgeon of National Taiwan University Hospital issued a statement on Facebook "Why I finally decided to abandon surgery to the United States." In an interview with Prof. Wei Wei, the authority of cardiac surgery in Taiwan’s Zhenxing Hospital, the Chinese health industry published “Wei Wei: From the “best” to “crash” what happened to Taiwan’s health insurance.

Established in 1995, the Taiwanese health care system known as the “Miracle of Medicare” is really nearing its “crash”? With doubt, the China Medical Network Medical Center medical channel exclusively interviewed Professor Wang Renxian, the commander of the Central District infectious disease prevention and treatment network of the Department of Disease Control of the Department of Health of Taiwan and the municipal adviser of the Taichung City Government.

“Taiwan’s health insurance system is still the best system”

China Network Reporter: The Taiwan health insurance system established in 1995 was praised by many countries and many media outlets. The Economist ranked Taiwan’s medical care as the second largest in the world. The American Broadcasting Corporation and the New York Times also praised Taiwan’s health insurance on many occasions. What is the status of the best medical insurance that is recognized worldwide?

Wang Renxian: I think the best system is still the best. There will be some minor problems that need to be corrected. At present, Taiwan’s health administrative unit is undergoing reforms. This health insurance system is a miracle of the world and Taiwan will certainly allow it to operate in an orderly manner. In this business process, we have made medical miracles at the expense of excessive profits of doctors and hospitals. Afterwards, Health Insurance will give them appropriate profits, but the general direction of the policy will not change.

The greatest feature of Taiwan Healthcare is medical expenses for all patients, regardless of illness or illness. This policy was originally intended to pull votes, and the entire population regards medical insurance as social welfare. No one thought that it would succeed, because the needs of the people must have increased with each passing day. As a result, it had succeeded.

China Network Reporter: No one thinks it will succeed. What is the reason for its ultimate success?

Wang Renxian: Four words, open source and reduce expenditure. All people think that the medical needs of the common people are increasing day by day. What the Taiwan government has done very well is to manage and guide this demand through science. At the same time, it has kept a steady investment, not shrinking, and it has achieved success. This miracle.

Because people’s medical expenses come from public funds, that is to say, 95% of medical expenses are from medical insurance, and medical insurance belongs to the Ministry of Health. Therefore, although 60%-70% of hospitals in Taiwan are private hospitals, they must also be managed by the Ministry of Health. In this case, only one and only employer in the medical institution is the medical insurance.

Over the years, medical technology has continued to advance and costs have gradually increased. Medical insurance in Taiwan has remained at around 5% of GDP for nearly 20 years. The government has not increased investment, but the effect of health insurance has been maintained. This is mainly due to several approaches.

The first one is the concept of revenue-generating and throttling. "Throttle" means that the patient does not come to the hospital. The government will spend a lot of energy to teach the people that the hospital is not good. Not all diseases must be solved in large hospitals. We all know that Chinese people like to see a doctor. If they don’t want the money, they will go to the hospital. Taiwan is a democratic society and cannot be forced to go. Only through scientific health education can the general public not have to go to the hospital to take care of the disease, and the concept of science should be popularized by eating too much medicine.

The second is to prevent doctors from over-prescription, over-prescription, and over-treatment. In the past, doctors liked to treat minor illnesses as serious because doctors were paid for their workload during the doctor's visit. This part must be under pressure, of course, the doctor will be unhappy after the pressure. Health insurance requires medical quality. Because of the increase in costs, the doctor's income is virtually reduced. For so long, health insurance has accounted for about 5% of GDP, and doctors have done more and more work and have long been resentful. The government must make people aware that "drugs are bad things, hospitalization is bad things, and they can go out-patient clinics." In this way, people are prevented from using medical insurance without restriction, and everyone's worry about health insurance is reduced.

Taiwan Health Insurance does not guarantee luxury medical China Network Reporter: Many people say that Taiwan’s medical insurance is to use the least money to achieve the highest quality?

Wang Renxian: Yes, our current premium has not increased. We have been using a certain amount of investment to achieve quality universal health care. During the past 20 years or so, medical technology has progressed, but drug costs have not progressed, and it has been hailed as a miracle. In the middle of this, we have suppressed a lot of medical waste. This waste includes both hospital-side and patient-side. The current waste is still very serious. I see a lot in the Mainland. Because according to the common people's habits, objectively speaking, over-medical patients also like it, and doctors also like it.

China Net Reporter: It has been said that Taiwan’s medical insurance has become a kind of welfare, and medical insurance should be a guarantee of basic medical care, rather than an extravagant medical treatment.

Wang Renxian: There is no extravagant medical care in Taiwan. The extravagant medical care is the hospitalization environment. Medical services are well-paid. Taiwan’s medical insurance has the spirit of welfare. It achieves the goal of welfare through medical pressure. The real insurance should be frail and sick people should give more money, people who are lightly ill, young people, and low premiums for prime years. But we are all equal. According to income, the rich will pay more, this is equivalent to a kind of tax, and the tax is welfare.

Taiwan is a low-tax country. Many people evade tax and cannot receive it. Many wealthy people, he pays some taxes, and is eligible for health insurance through premiums that do not match his income. Only when civil servants in public office, or those in our salaried class, can escape tax, our taxes are paid by the salaried people. Poor people do not receive taxes. We can help him with some benefits. However, it is very bad for the rich people to let us help him out.

The Taiwan health insurance system now also needs to improve the China Network reporter: There have been many reports in the media recently, saying that Taiwan’s health insurance is heading for a “crash,” what do you think?

Wang Renxian: I think that our health insurance system is still very good. It has improved the quality of medical care and lowered the unjustified income of hospitals and doctors. Now it only needs improvement.

With the development of society, the disease will continue to increase and new health problems will emerge. After all, medical technology is also progressing, and medical devices and drugs are advancing. At this time, the profits of the medical industry are getting thinner and thinner, and as much money as the doctors give, so no one in the hard work department is willing to do it. This is an important reason for the crash. Inside and outside the women's and children's four major subjects, we are called "four are all empty", none of the four subjects to do.

Another reason, because the hospital's profits are too thin, thin to some hospitals will be drained. Because of the small profits, the service volume must be large enough to support costs. A grass-roots hospital with less than 100 beds is difficult to operate in Taiwan, but these grass-roots hospitals are particularly needed by the people. Under this system, there will be large hospitals in Taiwan, and small hospitals will basically shrink. Taiwan is not without medical care, but medical advancement is very good, but it is on the small island of Taiwan that there are even islands of medical care.

China Network Reporter: In what areas does Taiwan's health care system still need improvement?

Wang Renxian: Taiwan's medical insurance can't just focus on big hospitals. If it goes on, big hospitals will grow bigger and bigger, and small hospitals will be wiped out. Now that Taiwan is reforming the issue of “payment,” the price of medical care is divided. The best way is to tie the money for doctors to the point where this problem does not arise. At the beginning, doctors would be able to make more money by seeing more of the disease. This is to serve the general public.

At present, the population of Taiwan is declining. There are not many people who need medical treatment and do not have much service. I think that the doctor should be given a fixed salary so that he can do a good job of quality and then encourage the primary medical care with the corresponding system. In fact, there are also some practices to encourage primary health care. It is just that there has been no adjustment by Medicare.

Some time ago, there was a single incident in Taiwan where one person was hit by a car at the entrance of a small hospital and sent to this hospital. As a result, the hospital said that he could not be cured and he needed to go to another big hospital that was far away. In the entrance to the hospital, it is not possible to treat the hospital because the hospital is empty and can only see a few minor illnesses. This is a crash and is actually a collapse of a primary hospital.

China Nets Reporter: It is said that when the Taiwan Health Insurance Bureau pays the hospital another health insurance fee, it will discount it.

Wang Renxian: The discount is that this medical expense has risen too fast. Since the beginning of the medical insurance, the responsible people were all laymen, and for a long time they had just touched the door. In the past, it was simply hacking. When it wasn’t enough money, it was cut down and the proportion was pressed down. Then the profit was cut off. Of course, the illegal operation of the hospital was cut. In fact, you can't blame the health insurance bureau because some unnecessary demands are limited.

Many hospitals “have policies under their own policies” and reported “reporting” at the time of the report. Medicare is also very clear about its own, it only makes you a little thin, so those complaining hospitals are actually complaining about their profits. Basically, there are still profits. Without profit, the industry has long since died.

Before Taiwan, medical care was poor. A person's illness may lead to bankruptcy. Through such quality control, the health insurance system is moving toward formalization, and if the medical treatment is regular, it requires the informal medical reports to refuse to pay. Taiwan Medical Insurance has an “upside down” policy. If you operate illegally, the Health Insurance Bureau will give you an undercut. The more you violate the rules, the higher the multiples will be. You will deduct both the hospital and the doctor. From this perspective, it is good for the people.

The doctor is still the most desired industry in Taiwan. China Network Reporter: I have heard that in Taiwan, many expensive medicine people can use it, which is much more affordable than the mainland.

Wang Renxian: This benefited from the medical insurance's nuclear price system. Because all medicinal materials, medical materials, and medicines are covered by Medicare, Medicare divides the use of the medicines and provides a bargain with the company. After the new drug comes out, it will check the price; when the protection period expires, the price will drop.

In mainland China, there are many differences in the price of medicines, and the ex-factory price and final sales price are very different. This will allow manufacturers to provide room for money, which will encourage the increase in the price of medicines. Taiwan can minimize the space for such money.

In Taiwan, our doctor's income is about 3-5 times that of the normal working class. The training period of the doctors is very long. Plus, the Taiwanese men have 2 years as soldiers. It takes 14 years to train such a talented person and the salary is 3-5 times basically acceptable. However, we do not want doctors to have huge profits because this is a public resource and the medical industry has its own public welfare.

China Network Reporter: The medical reform in the mainland is now implementing a system for the registration of medical expenses. The number of experts is not the same as the medical expenses of the regular number.

Wang Renxian: It is equal in Taiwan. The doctor is nominated or no doctor is appointed. As long as the doctor agrees, it can be seen. There is no money added to the consultation. This will allow doctors to progress, and it will prevent all patients from concentrating on one expert. He is limited. However, this limit number is usually not limited, the proportion of restrictions is very low, most patients can hang up to the doctor he wants. In this way, hospitals are more service-oriented, there are no big-name doctors, and all of them serve the people.

China Nets reporter: How is the current year's graduates in Taiwan concerned about the career of doctors?

Wang Renxian: I still yearn for it. Because when the Japanese ruled Taiwan, Taiwanese could not learn from law and politics, but only studied medicine and agriculture. Therefore, the best discipline in Taiwan is medicine and agriculture, and agriculture is also very good, because first-rate talents go to study medicine and agriculture. Over the years, Taiwan has not changed, and medicine has always been the first choice. For example, the Department of Medicine of my National Taiwan University recruits the top 70 individuals in Taiwan every year. It still remains.

Separate medicine, Taiwan also needs to be a reporter for the China Network: The mainland is now implementing a pilot medical reform called “separation of medicines.” What experience does Taiwan have that we can learn from?

Wang Renxian: Regarding the pharmaceutical industry, Taiwanese medicine is not doing well. It can only be said that the government has done a good job in suppressing prices. During the Japanese rule, Taiwan doctors did not charge after seeing a patient. My classmate just graduated from the countryside and gave him a doctor. After the illness, the patient sent him a cow.

Initially, medical insurance settings did not include medical treatment fees. Doctors rely on medicine to make money after seeing a doctor, so the profits of early medicine become doctor's money, so doctors do not have the power to prescribe medicines. Later, with the medical treatment fees in Taiwan, slowly, the profits of the medicines dropped, before the medicines gradually took shape.

Taiwan is still in an intermediate period. Taiwan's pharmaceutical industry is not doing well. I am very much in favor of pharmaceutical division.

China Network Reporter: In the mainland, in some areas of the pilot hospitals for medical reform, there has been no 15% drug addition, and all of them have been cut off. This part of the money is financed by subsidies and medical expenses for doctors.

Wang Renxian: In Taiwan, because hospitals and doctors have been squashed, they must rely on medicine to make money. Medical insurance to give a price, the hospital to buy the price is lower than the medical insurance, generally much lower, to see if you sell the vendor does not sell it? If you don't sell me, you won't enter, forcing the vendors to sell, and the manufacturers will not sell them. This is what we call the "drug price black hole."

The Ministry of Health of the black hole is very clear, but it does not dare to move. A hospital will die when it is moved. This accounted for 40% of the hospital's income, and the Ministry of Health did not dare to move. Therefore, it became a manufacturer, a doctor, and a hospital to use their own interests to support Taiwan's health insurance. It was a consortium that made money. This is a necessary change.

Establishing a “Disaster Fund” to Reduce Sharp Conflicts Between Doctors and Patients China Network Reporter: In the past two years, conflicts between doctors and patients in mainland China have frequently occurred. I do not know how the doctor-patient relationship in Taiwan is? How does the Taiwan authorities handle the relationship between doctors and patients?

Wang Renxian: As with this side, it is also quite tense. However, the response of ordinary people in Taiwan will be more gentle than that of Sven. It requires a majority of economic compensation.

What the people want is to get some compensation after a dispute occurs. The government has done a few measures in this respect. One is the phytotoxicity part, which is funded jointly by doctors, pharmaceutical companies and hospitals to establish a phytotoxicity fund. As long as the patient has a problem with a drug that meets the requirements, then the fund will be allocated 2 million Taiwan dollars, almost 500,000 yuan for you. But not to block your mouth. You have to tell the doctor and you can tell him. You think he is wrong. You have to tell him to let him accompany you. Then the 2 million will be recovered. But you may find this doctor to discuss less than 2 million so much money, you lose, 2 million to you, or yours.

Reduce medical malpractice cases through this form. In order to avoid imposing criminal compulsion on the civil law, it is now necessary to legislate and out of a medical accident. Whose fault is the compulsory sanitation of the Health Bureau? Do not take it to a criminal case. If the real doctor has criminal responsibility, then use criminal.