Addressing Challenges

Polarization on Taiwan's Healthcare Satisfaction Rate

While 90% of the Taiwanese are satisfied with the National Health Insurance (NHI), healthcare professionals express a mere 30% satisfaction with the same system. This disparity highlights issues stemming from long working hours, arduous labor, the dilution of hospital and clinic revenue due to the "NHI Global Budget Control," and the failure of the tiered referral system, all of which have resulted in a decline in healthcare quality.

Taiwan's nursing workforce has a practice rate of only 58% and an average career span of just 6.5 years. Severe healthcare manpower shortages persist, with over half of medical professionals experience burnout.

According to the Ministry of Health and Welfare's projections for 2024, Taiwan will face a shortage of 24,000 nurses and the situation will exacerbate with the challenges of an aging population. Taiwan's nurse-to-patient ratio has reached 1:13, with one nurse caring for 13 patients on average, sometimes even as high as 1:20. In contrast, Japan's ratio stands at 1:7, South Korea is 1:10, and Singapore is less than half of Taiwan's at 1:6.

Vice President Lai Ching-te has proposed the "Long-term Care 3.0," aiming to diversify the national examination for nursing personnel, expand the enrollment quotas for university nursing programs, and address the manpower shortage by legalizing the nurse-to-patient ratio. However, this proposal has faced opposition from nursing professionals, who argue that it is severely detached from the realities of healthcare settings.

Excessively high nurse-to-patient ratios lead to rising patient mortality rates, infection rates, falls, and pressure sore incidence. The high-stress, high-risk burnout, low wages, and poor working conditions in nursing contribute to a vicious cycle of the nursing staff resignation in Taiwan.

Financial Predicament of the National Health Insurance

The National Health Insurance (NHI) has incurred losses for five consecutive years. As Taiwan is set to become a super-aged society in 2025, healthcare expenditures are expected to increase. Presently, Taiwan's healthcare budget only accounts for 6.6% of GDP, falling short of the 8% target set by President Tsai’s administration. Limited resources have increasingly caught Taiwan's healthcare environment in predicament.

When compared to other advanced countries, Taiwan's allocation to healthcare spending as a percentage of GDP is significantly lower. On average, OECD countries allocate 9.6% of their GDP to healthcare, with Japan at 11%, South Korea at 8%, and Hong Kong at 7.3%. Taiwan's comparatively low investment in healthcare, combined with its heavy focus on health insurance rather than healthcare, does not contribute to raising the overall health level and extending the life expectancy and life quality of the Taiwanese people.

Sustainable Healthcare Financing is Essential for the Health of Our Nationals

An Aging Population without adjusted Standards for Caregiver Application
 As medical technology advances, Taiwan's average life expectancy continues to increase from 79.2 years in 2010 to 81.3 years in 2020. However, the aging population is growing too quickly, creating a slew of medical and care challenges.

The proportion of individuals aged 65 and above varies across different administrative districts in Taiwan, with Chiayi County having the highest at 21.69%, followed by Taipei City at 20.91%, Nantou County at 20.13%, and Yunlin County at 20.12%. Conversely, Taoyuan City has a higher influx of younger residents, with the elderly making up 14.28% of its population, while Hsinchu County has 13.64%.

The rising number of elderly has also led to a rising dependency ratio, growing from 34.7 in 2012 to 42.2 in 2022 (this indicates the number of children and the elderly per 100 working-age individuals). Projections for 2060 indicate that the ratio will exceed 100, and reach 109.1 by 2070, placing heavier pressure on the so-called "sandwich generation."

Many families opt to hire foreign caregivers for their elderly family members. However, the current application of Barthel Index (BI), used for assessing caregiving qualification, has been criticized for failing to comprehensively address the subtle nuances of care requirements. This issue has not only led to conflicts between healthcare providers and patients, but also compromised care quality.

Solutions

Investing in Health, Ensuring Effective Healthcare, and Sustaining the National Health Insurance:
1. Increase healthcare expenditure to 8% of GDP.
2. Promote healthy lifestyles through exercise, weight management, smoking cessation, cancer screening, managing hypertension, and regular health checkups.
3. Expand the range of publicly-funded vaccines to include rotavirus, enterovirus, and enhanced chickenpox, alleviating the financial burden on families.
4. Implement the family physician system, tiered healthcare system, referral system, and remuneration based on capitation.
5. Liberalize the self-payment healthcare market:

• Lift the ban on single-person rooms, ensuring protection for those covered by NHI.
• Allow early access to the latest medical materials in the self-payment market after their approval, so the public can benefit from cutting-edge medical technologies.
• Make the self-payment healthcare market more transparent and protect people's rights.

6. Provide comprehensive care, eliminating worries about inpatient nursing care.
7. Simplify review process for hiring foreign helpers:

• Eliminating requirement of Barthel Index for elderly and frail individuals to hire foreign helpers.
• Simplifying the assessment process for disabled individuals to hire foreign helpers.  

8. Fully subsidize health insurance premiums for those aged 65 and above.