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United Daily News 2008/01/17
Reporter Wang Wenling / Taipei Report
The Taipei Central Clinic was fined NT$50,000 by the Health Bureau for charging patients a "physician designation fee." The Central Clinic disagreed with the penalty and filed an appeal and administrative lawsuit. The Taipei High Administrative Court ruled that the Central Clinic had illegally established the fee without prior approval from the competent authority, resulting in a loss for the clinic. Many hospitals charge a "physician designation fee," especially for surgeries or deliveries by designated physicians. This court ruling may impact current doctor-patient relationships. The Taipei Health Bureau informed the court that the issue of the physician designation fee involves medical practices, medical ethics, and doctor-patient relationships. Although the Medical Care Act stipulates that such fees should be approved by municipal or county authorities, the broad implications warrant careful consideration. The judges agreed with the Health Bureau's reasoning.
The Taipei Health Bureau received complaints from patients and, after investigation, the Central Clinic admitted that a patient had visited four times between July and October 2005, with fees ranging from NT$3,500 to NT$13,000 for designated physician services. The Health Bureau noted that when the "Taipei City Western Medical Hospital and Clinic Fee Schedule" was revised in 2005, it specified that the physician designation fee would require approval from the Department of Health, Executive Yuan, before being implemented. The Central Clinic violated the Medical Care Act by charging the fee before approval and was fined the minimum penalty of NT$50,000. The Central Clinic argued that patients had agreed to and signed consent forms for the fee, and refunds were issued upon request, so they should not be penalized. They also claimed that the physician designation fee is not covered by the National Health Insurance and is not an unauthorized charge. The Health Bureau's refusal to include the fee in the standard schedule left them without guidance. The Taipei High Administrative Court ruled that the Central Clinic had unlawfully established the fee, effectively increasing costs for patients, and upheld the Health Bureau's fine.
Central Clinic: Fee is in line with the National Health Insurance Act
[Reporter Hong Jiayu / Taipei Report]
The Taipei Central Clinic stated that, according to Article 39 of the National Health Insurance Act, charging a physician designation fee is legal. The clinic communicates with patients before charging the fee, with amounts varying based on the patient's condition, not exceeding NT$10,000, and receipts are issued. The clinic also noted that they often reduce or waive the fee for financially disadvantaged patients. Gao Weijun, Director of the Medical Care Management Division of the Taipei Health Bureau, stated that charging a physician designation fee is currently illegal in Taipei, hence the NT$50,000 fine for violating the Medical Care Act, and the clinic is required to refund the fees collected from patients.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00e. html
"Red Envelope on the Table" – Finding a Renowned Doctor Costs at Least 20,000 to 30,000 NT
2008/01/17 Reporters: Jianfu Zhan, Huihui Chen / Taipei Report
The "designated doctor fee" has been in practice for years. Some doctors openly admit it's a way to legitimize red envelopes, while others argue that calling a doctor in the middle of the night for a delivery should warrant reasonable compensation. The Medical Reform Foundation, however, worries it could lead to medical classism and suggests the Department of Health abolish the practice.
It's understood that doctors who charge designated fees are mostly from so-called "noble private hospitals." They don't charge this fee for regular consultations, but for surgeries or deliveries where a specific doctor is requested, a designated doctor fee is applied. The fee varies with the doctor's reputation, ranging from thousands to tens of thousands of NT dollars. For example, delivering at Taipei Adventist Hospital with the same doctor who performed prenatal check-ups costs an additional 3,000 NT in designated fees.
Some doctors privately reveal that a renowned obstetrician charges 20,000 to 30,000 NT for designated services, openly acknowledging that his skills and experience far surpass those of younger doctors. A neurosurgery clinic in central Taiwan also states on its website that patients requesting a specific doctor for hyperhidrosis surgery under health insurance, rather than self-pay, must pay a designated doctor fee.
One doctor points out that the designated doctor fee is akin to a patient giving a red envelope, except it's done openly rather than secretly. They argue that it's better to have such practices out in the open. Another doctor mentions that if all patients pay the same consultation fee, they should receive the same level of service. However, expecting better or more specialized service naturally comes with a higher cost.
Dr. Cheng Cheng-Chieh, director of the Gynecologic Cancer Center at Taipei Medical University Hospital, believes that since each doctor's experience and reputation differ, he doesn't oppose the designated doctor fee. However, he suggests that health authorities should set a cap on such fees to avoid putting pressure on the less affluent.
That said, Dr. Cheng notes that charging a designated fee isn't necessarily beneficial. Accepting such fees increases the pressure on doctors, and patients who pay extra won't tolerate any mistakes or complications. He emphasizes that regardless of whether a designated fee is charged, conscientious doctors will always take good care of their patients.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00f. html
2008/01/17 Reporters Chen Huihui and Zhan Jianfu / Taipei Report
Zhou Daojun, the section chief of the Department of Medical Affairs at the Department of Health, stated yesterday that the physician designation fee is considered a medical expense. According to Article 21 of the Medical Care Act, the standards for medical fees are determined by the local health bureaus of each city and county. Overcharging can result in penalties.
The Bureau of National Health Insurance pointed out that the physician designation fee is not covered by the national health insurance. If disputes arise between patients and hospitals over the payment of this fee, the bureau will refer the matter to local health authorities for handling. The Taipei Medical Association expressed frustration, noting that they have been applying to the Taipei City Health Bureau every few years to adjust the medical fee schedule. However, the issue of the physician designation fee has been unresolved due to the health bureau and the Department of Health passing the buck to each other.
Zhou Daojun mentioned that the Taipei City Health Bureau penalizes medical institutions for charging the physician designation fee, whether it's for creating new fee categories or setting the fee at zero. The Department of Health will further investigate this matter. Zhou emphasized that while medical institutions can charge a physician designation fee, they cannot set exorbitant prices. According to the Medical Care Act, medical fee standards must be reviewed and approved by the local medical affairs review committee.
An official from the Bureau of National Health Insurance privately revealed that the physician designation fee has been a long-standing practice in some private hospitals. Most patients who seek treatment there are willing to pay the fee, accepting it as part of the process.
The Taipei Medical Association stated that their last adjustment to the medical fee schedule was at the end of 2005. However, regarding the physician designation fee, the Taipei City Health Bureau noted in the approved document: "The fee standard for the physician designation fee must be agreed upon by the Department of Health and then separately approved." The confusion over whether the physician designation fee can be charged, with differing views between central and local authorities, has left physicians in a dilemma.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00g. html
Hospital Charging Doctor Designation Fees Illegal
Reporter Wang Wenling / Taipei Report
The Taipei Central Clinic was fined NT$50,000 by the Health Bureau for charging patients a "physician designation fee." The Central Clinic disagreed with the penalty and filed an appeal and administrative lawsuit. The Taipei High Administrative Court ruled that the Central Clinic had illegally established the fee without prior approval from the competent authority, resulting in a loss for the clinic. Many hospitals charge a "physician designation fee," especially for surgeries or deliveries by designated physicians. This court ruling may impact current doctor-patient relationships. The Taipei Health Bureau informed the court that the issue of the physician designation fee involves medical practices, medical ethics, and doctor-patient relationships. Although the Medical Care Act stipulates that such fees should be approved by municipal or county authorities, the broad implications warrant careful consideration. The judges agreed with the Health Bureau's reasoning.
The Taipei Health Bureau received complaints from patients and, after investigation, the Central Clinic admitted that a patient had visited four times between July and October 2005, with fees ranging from NT$3,500 to NT$13,000 for designated physician services. The Health Bureau noted that when the "Taipei City Western Medical Hospital and Clinic Fee Schedule" was revised in 2005, it specified that the physician designation fee would require approval from the Department of Health, Executive Yuan, before being implemented. The Central Clinic violated the Medical Care Act by charging the fee before approval and was fined the minimum penalty of NT$50,000. The Central Clinic argued that patients had agreed to and signed consent forms for the fee, and refunds were issued upon request, so they should not be penalized. They also claimed that the physician designation fee is not covered by the National Health Insurance and is not an unauthorized charge. The Health Bureau's refusal to include the fee in the standard schedule left them without guidance. The Taipei High Administrative Court ruled that the Central Clinic had unlawfully established the fee, effectively increasing costs for patients, and upheld the Health Bureau's fine.
Central Clinic: Fee is in line with the National Health Insurance Act
[Reporter Hong Jiayu / Taipei Report]
The Taipei Central Clinic stated that, according to Article 39 of the National Health Insurance Act, charging a physician designation fee is legal. The clinic communicates with patients before charging the fee, with amounts varying based on the patient's condition, not exceeding NT$10,000, and receipts are issued. The clinic also noted that they often reduce or waive the fee for financially disadvantaged patients. Gao Weijun, Director of the Medical Care Management Division of the Taipei Health Bureau, stated that charging a physician designation fee is currently illegal in Taipei, hence the NT$50,000 fine for violating the Medical Care Act, and the clinic is required to refund the fees collected from patients.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00e. html
"Red Envelopes on the Table: Finding A Renowned Doctor Costs at Least 20,000 to 30,000"
2008/01/17 Reporters: Jianfu Zhan, Huihui Chen / Taipei Report
The "designated doctor fee" has been in practice for years. Some doctors openly admit it's a way to legitimize red envelopes, while others argue that calling a doctor in the middle of the night for a delivery should warrant reasonable compensation. The Medical Reform Foundation, however, worries it could lead to medical classism and suggests the Department of Health abolish the practice.
It's understood that doctors who charge designated fees are mostly from so-called "noble private hospitals." They don't charge this fee for regular consultations, but for surgeries or deliveries where a specific doctor is requested, a designated doctor fee is applied. The fee varies with the doctor's reputation, ranging from thousands to tens of thousands of NT dollars. For example, delivering at Taipei Adventist Hospital with the same doctor who performed prenatal check-ups costs an additional 3,000 NT in designated fees.
Some doctors privately reveal that a renowned obstetrician charges 20,000 to 30,000 NT for designated services, openly acknowledging that his skills and experience far surpass those of younger doctors. A neurosurgery clinic in central Taiwan also states on its website that patients requesting a specific doctor for hyperhidrosis surgery under health insurance, rather than self-pay, must pay a designated doctor fee.
One doctor points out that the designated doctor fee is akin to a patient giving a red envelope, except it's done openly rather than secretly. They argue that it's better to have such practices out in the open. Another doctor mentions that if all patients pay the same consultation fee, they should receive the same level of service. However, expecting better or more specialized service naturally comes with a higher cost.
Dr. Cheng Cheng-Chieh, director of the Gynecologic Cancer Center at Taipei Medical University Hospital, believes that since each doctor's experience and reputation differ, he doesn't oppose the designated doctor fee. However, he suggests that health authorities should set a cap on such fees to avoid putting pressure on the less affluent.
That said, Dr. Cheng notes that charging a designated fee isn't necessarily beneficial. Accepting such fees increases the pressure on doctors, and patients who pay extra won't tolerate any mistakes or complications. He emphasizes that regardless of whether a designated fee is charged, conscientious doctors will always take good care of their patients.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00f. html
Health Ministry: Fees Allowed but Must be Reasonable under Medical Law
Zhou Daojun, the section chief of the Department of Medical Affairs at the Department of Health, stated yesterday that the physician designation fee is considered a medical expense. According to Article 21 of the Medical Care Act, the standards for medical fees are determined by the local health bureaus of each city and county. Overcharging can result in penalties.
The Bureau of National Health Insurance pointed out that the physician designation fee is not covered by the national health insurance. If disputes arise between patients and hospitals over the payment of this fee, the bureau will refer the matter to local health authorities for handling. The Taipei Medical Association expressed frustration, noting that they have been applying to the Taipei City Health Bureau every few years to adjust the medical fee schedule. However, the issue of the physician designation fee has been unresolved due to the health bureau and the Department of Health passing the buck to each other.
Zhou Daojun mentioned that the Taipei City Health Bureau penalizes medical institutions for charging the physician designation fee, whether it's for creating new fee categories or setting the fee at zero. The Department of Health will further investigate this matter. Zhou emphasized that while medical institutions can charge a physician designation fee, they cannot set exorbitant prices. According to the Medical Care Act, medical fee standards must be reviewed and approved by the local medical affairs review committee.
An official from the Bureau of National Health Insurance privately revealed that the physician designation fee has been a long-standing practice in some private hospitals. Most patients who seek treatment there are willing to pay the fee, accepting it as part of the process.
The Taipei Medical Association stated that their last adjustment to the medical fee schedule was at the end of 2005. However, regarding the physician designation fee, the Taipei City Health Bureau noted in the approved document: "The fee standard for the physician designation fee must be agreed upon by the Department of Health and then separately approved." The confusion over whether the physician designation fee can be charged, with differing views between central and local authorities, has left physicians in a dilemma.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080117/ 2/ s00g. html