How Taiwan transformed its health care system
nytimes.com
nytimes.com
Taiwan's healthcare system is not perfect, but at least I don't have to worry about it. It is good AND affordable.
It is good AND affordable.
US GDP per capita is nearly three times that of Taiwan, incomes are likewise far higher.
It's equivalent to comparing costs in Switzerland versus Czech and being surprised that Switzerland is so much higher.
Having said that it's not just the income of doctor. Healthcare administration is expensive in the USA. Many doctors offices spend a non insignificant amount of money on just the billing, collection, insurance administration. The health insurance system as we naturally ended up with sucks up a non insignificant amount of money out of the system. It also leads to these weird distortions where every insured procedure is discounted to the insurance agency like 75%... But not if you deal direct.
Additionally, operational insurance (malpractice indurance) is another non-insignificant contributor. Our culture and our legal system ensure that many doctors practices will pay a multiple of a practitioners salary in malpractice and related salary.
If we want cheaper healthcare all of these need to be addressed one way or another. I am not hopeful that we can escape this local maxima that we're stuck in. Every attempt at change will be meet with fierce opposition from the current status quo.
https://house.ettoday.net/news/803652?t=%E4%BA%8C%E4%BB%A3%E...
I did enjoy getting an x-ray (ankle injury) + evaluation + a week of painkillers for $27 USD without insurance, though. I can only imagine what it would have cost in the US.
Taiwanese doctors don't get paid in money.
They get paid "credits" which have to be exchanged for money based on a parallel financial system.
Foreigners here sometimes complain that there's a focus on seeing more patients faster, so there might be a misdiagnosis or a less thorough examination.
The fact remains though - it's cheaper to fly here to have a wisdom tooth removed (without insurance) than the same operation would cost in Switzerland or the US. There isn't much resentment of medical tourism either - so, you're all welcome to visit!
Unless you already know what kind of specialist you need to go see, and you can afford to go see the right one (might involve multiple visits to multiple specialists), you might literally never get help for a chronic problem that is not obvious on a differential diagnosis.
There really needs to be two kinds visits available: quick visits and check ups, and diagnostic visits. The first can be over in 10 minutes, the latter should last a solid hour.
I'm starting to wonder if "diagnostician" should be a separate specialization. Then I could make an appointment specifically to go see the diagnostician, and not bother the general practitioner, who is evidently too busy to spend more than 15 minutes diagnosing something.
Internal medicine specialists are supposed to be "diagnosticians," as you envision it -- they have more training than general practitioners if they're internal medicine specialists. But they're one of the lower-paid specialties, in part because it's easy to charge for a stent or injection but in the US the act of diagnosing a problem doesn't really have a code.
He also didn't take insurance - because he didn't want to bother with it. And he wanted to be more honest in his notes than his libertarian heart felt comfortable disclosing to the insurance company or the government payers.
Every time in the past I suggested something like that to my current dentist they had the same reaction, basically: "Oh I would never do that! You're going to get an infection and/or they are going to do such bad work that no dentist here in the US will want to touch you afterwards."
Doctors in the US are so arrogant, thinking they are the best in the world because they are the most expensive. I would love to move to Taiwan, but I suffer miserably in the jungle weather (hence why I am going in winter).
Edit: As someone with chronic health issues in the US, I have a laundry list of horror stories about doctors here. They are far, far from the best in the world.
With a global economy, I don't understand how we manage to stay competitive. Same goes for Silicon Valley vs the rest of the U.S. I don't understand how there can be such a price differential, and yet the most pricey places seem to win economically.
It took a bit longer for me, a second dentist came to help towards the end.
Compared to over $400 USD insured in the US.
The cheapest SFO<->TPE flights cost $468.
It might not work out cheaper for you, depending on your insurance plan, but it should be thought of as a serious option for all non-emergency operations.
http://michaelturton.blogspot.tw/2007/04/life-among-toothles...
After that's healed, I have to get a replacement tooth mounted on the post and that's another $2000ish. I believe my dental plan will cover $1000 of that.
I don't understand how an implant can cost $4000. It was an hour of time in a dentist office. It seems about an order of magnitude too much. FWIW, I had two estimates and that was the lower one.
> They get paid "credits" which have to be exchanged for money based on a parallel financial system.
This is really interesting. Had a quick google and couldn’t find anything. Do you have a link with more details?
Maybe he means doctors get paid with status, and if you're a doctor you get better rates for loans.
All I know is what a medical student at church told me - I'll have to confirm later. But I know that it's not payment as status - the doctors' salaries are set in a parallel currency, which has a changing exchange rate with real NTD. I'll find out and reply.
But.... Medicine is not really an ordinary market, most places. It's not really a market in the US and Europe, in the sense that prices are set like other services. A big determinant of costs tends to be how well the system works.
My wife went back to her hometown in southern Taiwan a few years ago to help take care of her ailing father. One day while at the hospital she saw a tour bus pull up, and forty tourists from mainland China disembark. Their tour of the local sites included a checkup and some tests by the doctors in the hospital. Works out well for them and the hospital, which is not nearly as busy as the facilities in Taipei.
People clogging up emergency care facilities with common colds and minor ailments is common (as noted by others on this thread). There are several negative side effects including patients expecting to be prescribed something even if it's not warranted. If it's antibiotics, that's a problem because people can build resistance to antibiotics. I also believe there can be a kind of assembly-line mentality taking over among the staff at some busy facilities, with doctors spending only a few minutes with each patient. This can unfortunately lead to truly serious cases being overlooked.
For chronic conditions, the quality of care varies quite a bit. One complaint I've heard several times is sometimes there is no coordination between specialists -- it's up to the patient or family members to reach out and make appointments and communicate test results and the conclusions of other doctors. Lots of things can go wrong, and I fear some patients fall between the cracks.
Dental care can be very good and very inexpensive - my dentist here in the U.S. has complemented the skills of the dentists back in Taiwan who put in crowns years ago.
https://english.cw.com.tw/article/article.action?id=1662
It matches the complaints I've heard from several nurses quite well. Idiots with a harmless common cold clog hospital waiting rooms just because it's cheap and convenient. Not just doctors, but also nurses are underpaid and will jump ship if they can.
In France, my country, a tooth cleansing is closer to 60 usd, and a x ray is closer to 70 usd. I guess in the US its even more.
Super satisfied with Taiwan healthcare system!
This in turn bites those that try to pay directly, as they end up with sticker shock.
When my father had cancer treatment, he sometimes asked for the public hospital (shared ward, less lonely when he was feeling OK but had to spend days in a bed) and other times the private hospital (doctors and nurses had more time, but the treatment was the same and he had a private room).
These seems to most often crop up around non-critical issues like joint paints etc.
And i have yet to find a single payer system that do not let you go abroad for elective care, if you can find the funding. They will however not fund your trip unless there is a strong case made for there being no viable alternatives back home.
But at the end of the day society has to decide whether or not healthcare for everyone is something worth spending money on. And that's were the US fails imo: no sense of a shared community.
Grand total for 24 months of the best care in the world?
$8,000 in deductibles.
I don't doubt that other healthcare systems are well run, but after my family's ordeal, I came away pretty impressed with our system. Treating cancer for less than the price of a well-worn car is pretty darn impressive.
How much do people have to pay?
A.
If you’re employed, your employer pays 60 percent of your premium. The employee pays 30 percent, and the government subsidizes 10 percent. The government fully subsidizes the premiums for the poor and gives partial subsidies to veterans, the self-employed and farmers.
Q.
How much is the typical premium?
A.
The total insurance premium for employed workers is 4.6 percent of wages. That’s much lower than in the United States, where the average is between 12 and 20 percent of wages for those who are covered by their employers.
It's foolish to keep talking about healthcare without talking about (personal) health (including diet and lifestyle).
Reforming the healthcare system of a relatively young and healthy society is relatively easy (read: doable). On the other hand, "fixing" a healthcare system of a country (e.g., USA) that's aging and more importantly fond of "acquiring" preventable conditions (e.g., obesity, type 2 diabetes, etc.) and you will always be going sideways.
Yes, there is room for improvement in the USA. But that's still not going to fix the disgusting amount of resources wasted on the preventables.
If healthcare is going to be a right then personal health is the responsibility that must be paired with this right. Thus far the USA isn't interested in the discussion of the latter.
http://askakorean.blogspot.com/2010/01/healthcare-system-in-...
It seems to be an efficiently run program.
This does not seem like a positive lesson.
What they didn't mention, is that often med students get their studies paid by one of the hospitals and then are tied to that hospital up to 7-ish years at depressed salaries --which is likely contributing to the shortage.
>Taiwan, in contrast, revamped its top to bottom.
Sorry, "its" what? Copy editors, please.
Imagine the sentence "Alice tinkers with her health care system. Bob revamped his." It's the same concept, but with "its" as the pronoun.
Can you expand on what the mistake is?
Taiwan, in contrast, revamped its [own|healthcare|something] top to bottom.
Otherwise it looks like "Taiwan, in contrast, revamped its [top] [to [the] bottom]."
It's not missing the antecedent, it's near the end of the previous sentence, just like the other person you replied to said.
Singapore, which we wrote about in October, tinkers with its health care system all the time. Taiwan, in contrast, revamped its top to bottom.
The its clearly refers to health care system from the previous sentence.
In other words it's typically used as a possessive determiner in this construction.
It's somewhat similar to the following:
-Have you eaten?
-Yes, I've.
But lets not overlook the elephant in the room.
Taiwan is an island full of thin people who eat rice or noodles at almost every meal. Millions of people still shop primarily at traditional markets and millions of others follow Buddhist diets that would be mocked by western "diet hackers". Only in the past generation has it really begun adopting, and suffering the effects of, western eating habits.
If Taiwanese people ate like Americans and drove everywhere, their health care system would have become bankrupt years ago.
Preventive healthcare should be pushed more. But remember when Michelle Obama said kids should eat more vegetables?
Jamie Oliver did a show in the US and kids didn't even know what some vegetables were. Jamie showed them potatoes, tomatoes, carrots they may as well been alien the kids didn't have a clue. https://www.youtube.com/watch?v=bGYs4KS_djg
[1]http://www.taipeitimes.com/News/editorials/archives/2016/04/...
"Finally, it began to institute global budgets — caps on the total amount paid for all care — in the hope of squeezing providers into becoming more efficient."
OK, what happens when a part of the system hits the cap in a given year? Rising obesity -> cancer/blood pressure/type 2 diabetes in a decade or two based on UK experience. In UK we spend a large % of GDP on the NHS but that % can't keep rising forever, so I'm interested in alternatives.
Also in corporate cafes, foods are still very traditional.
Notably their eyes are relatively poor. Almost 90% have corrected vision. Often in large meeting 100% will be wearing glasses.