Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
【By Gao Kepei】
On September 27, the day after a major healthcare group was exposed for allegedly defrauding the National Health Insurance (NHI) of over 400 million NT dollars, next year’s NHI budget of 590 billion NT dollars was finalized after discussions among medical and payer representatives.
**Controlling Medical Waste is the NHIA’s Responsibility**
Reports indicate that this was the most rational and peaceful NHI budget allocation in seven years. Some medical representatives expressed that while they were "not 100% satisfied," they seemed pleased that the outcome was close to their demands. The NHIA also completed its annual routine of "distributing the wool."
However, the media immediately questioned whether the current hospital sector budget—now double the total NHI expenditure when the program was launched 19 years ago—reflects improved healthcare quality, given the "voracious milking of NHI resources." Unfortunately, the NHIA’s "gentlemen" have yet to respond.
As a physician with nearly 40 years of experience, I fully agree with this question. While "nothing can be done without money," medical costs do not necessarily equate to medical quality.
Most people understand that quality healthcare means "providing all necessary treatments for patients." However, Taiwan remains a developing country where public awareness is still evolving. Many people—even officials—may not realize that "avoiding unnecessary treatments" is not just about cost-saving but also a hallmark of quality care.
The logic is simple: "performing unnecessary medical procedures" is wasteful, and all medical waste—including unnecessary surgeries, tests, and medications—harms patients to varying degrees. Therefore, "reducing medical waste" is equivalent to "improving medical quality."
Article 62 of the *Medical Care Act* specifically requires the central health authority to establish guidelines defining indications for certain medical technologies. Thus, controlling medical waste is naturally one of the NHIA’s responsibilities. But where are its actions and results?
Let me remind readers and the NHIA of the following news reports (all from *United Daily News*). If true, these would tarnish our proud NHI system internationally, just as the "gutter oil" scandal shamed Taiwan’s "gourmet" reputation:
**Unnecessary Surgeries Should Be Treated as Fraud**
1. **July 22, 2012**: Medical heavyweight and Deputy Superintendent of Koo Foundation Sun Yat-Sen Cancer Center, Xie Yanyao, criticized rampant medical waste at the "Protecting Taiwan’s Healthcare Summit." He condemned doctors who perform unnecessary surgeries and claim NHI reimbursements as outright fraud, stating they should be jailed.
Typically, these reckless surgeries are dubbed "golden goose procedures"—those that are "easy to diagnose, simple to perform, have few complications, and yield high fees." Examples include spinal and joint surgeries for bone spurs, where neck surgery is done for hand numbness and lumbar surgery for foot numbness. The demand is so high that Taiwan’s neurosurgeon density reaches 2.5 per million people, far exceeding the 1 to 1.5 in Europe and the U.S.
The same applies to "non-cancer gallbladder removals." Recently, even a "professor-physician" from National Taiwan University Hospital—an unquestioned icon in Taiwan’s medical community—could not clearly justify a judge’s gallbladder surgery. What about "average doctors" treating "average patients"?
2. **July 1, 2013**: "Excessive CT scans lead to 60% NHI claim rejections, with Taipei XX Hospital and XX Hospital facing over 90% rejection rates... In 2012, 1.5 million scans, plus MRIs and PET scans, cost 12.7 billion NT dollars annually." This means 60-90% of CT scans were unjustified. In the U.S., such hospitals (or doctors) would have been expelled from the insurance system long ago.
If this happens in Taipei, Taiwan’s most advanced city, imagine the situation elsewhere. Yet, our NHIA appears to turn a blind eye.What is even more alarming is that these hospitals have young student doctors. When senior doctors so casually dismiss the importance of "physical examinations" (i.e., the traditional Chinese medicine practices of observation, listening, questioning, and pulse-taking) and readily resort to expensive imaging tests, it becomes a case of "monkey see, monkey do." Young doctors mimic this behavior, learning only to prescribe tests during consultations, severely eroding the core values of medicine (Note: According to Wikipedia, radiation from CT scans can damage human cells and lead to cancer).
**February 27, 2013:** A hospital in Kaohsiung discards unused medication, recycling hundreds of kilograms monthly.
**November 22, 2013:** The amount of medication discarded annually in Taiwan, if stacked, would equal five Taipei 101 skyscrapers.
If these drugs are being thrown away by savvy patients because they are useless, imagine how many more useless medications are being consumed by patients who blindly trust their doctors.
According to a report by the "Drug Injury Relief Foundation," a multinational survey found that "Taiwanese consume seven times more medication than Americans. Even more concerning, in the U.S.—a country known for its strict medication standards—the daily death toll from improper drug use is equivalent to a Boeing 747 crash. Domestic pharmaceutical experts estimate that the hidden figures of disability and fatalities due to improper drug use in Taiwan may exceed those in the U.S. by more than sevenfold."
Who is prescribing these improper medications?
No wonder Taiwan has the highest rate of kidney disease in the world. So, who is responsible for prescribing these "improper medications"—the doctors or the patients themselves?
The wool comes from the sheep's back, and this year, the wool has been "successfully" sheared 3% more than last year. The medical industry's delight is understandable.
It is absolutely reasonable for the state to fund high-quality healthcare for its people. However, the author believes that if the National Health Insurance (NHI) authorities are indifferent, incompetent, or unable to curb waste—failing in their duty to protect (vulnerable and uninformed) citizens from the harms of "excessive medical treatment" and neglecting their responsibility to cut costs (eliminating malpractice while fostering benefits)—then they are no different from ancient bandits dividing spoils or modern-day fraudsters exploiting the NHI.
(The author is a physician in Taipei and the founder of the "Action Alliance for Chinese-Language Medical Records.")
Source: http:/ / mag. udn. com/ mag/ newss……torypage. jsp? f_ART_ID=539561
Draining Health Insurance: Has Medical Quality Improved?
On September 27, the day after a major healthcare group was exposed for allegedly defrauding the National Health Insurance (NHI) of over 400 million NT dollars, next year’s NHI budget of 590 billion NT dollars was finalized after discussions among medical and payer representatives.
**Controlling Medical Waste is the NHIA’s Responsibility**
Reports indicate that this was the most rational and peaceful NHI budget allocation in seven years. Some medical representatives expressed that while they were "not 100% satisfied," they seemed pleased that the outcome was close to their demands. The NHIA also completed its annual routine of "distributing the wool."
However, the media immediately questioned whether the current hospital sector budget—now double the total NHI expenditure when the program was launched 19 years ago—reflects improved healthcare quality, given the "voracious milking of NHI resources." Unfortunately, the NHIA’s "gentlemen" have yet to respond.
As a physician with nearly 40 years of experience, I fully agree with this question. While "nothing can be done without money," medical costs do not necessarily equate to medical quality.
Most people understand that quality healthcare means "providing all necessary treatments for patients." However, Taiwan remains a developing country where public awareness is still evolving. Many people—even officials—may not realize that "avoiding unnecessary treatments" is not just about cost-saving but also a hallmark of quality care.
The logic is simple: "performing unnecessary medical procedures" is wasteful, and all medical waste—including unnecessary surgeries, tests, and medications—harms patients to varying degrees. Therefore, "reducing medical waste" is equivalent to "improving medical quality."
Article 62 of the *Medical Care Act* specifically requires the central health authority to establish guidelines defining indications for certain medical technologies. Thus, controlling medical waste is naturally one of the NHIA’s responsibilities. But where are its actions and results?
Let me remind readers and the NHIA of the following news reports (all from *United Daily News*). If true, these would tarnish our proud NHI system internationally, just as the "gutter oil" scandal shamed Taiwan’s "gourmet" reputation:
**Unnecessary Surgeries Should Be Treated as Fraud**
1. **July 22, 2012**: Medical heavyweight and Deputy Superintendent of Koo Foundation Sun Yat-Sen Cancer Center, Xie Yanyao, criticized rampant medical waste at the "Protecting Taiwan’s Healthcare Summit." He condemned doctors who perform unnecessary surgeries and claim NHI reimbursements as outright fraud, stating they should be jailed.
Typically, these reckless surgeries are dubbed "golden goose procedures"—those that are "easy to diagnose, simple to perform, have few complications, and yield high fees." Examples include spinal and joint surgeries for bone spurs, where neck surgery is done for hand numbness and lumbar surgery for foot numbness. The demand is so high that Taiwan’s neurosurgeon density reaches 2.5 per million people, far exceeding the 1 to 1.5 in Europe and the U.S.
The same applies to "non-cancer gallbladder removals." Recently, even a "professor-physician" from National Taiwan University Hospital—an unquestioned icon in Taiwan’s medical community—could not clearly justify a judge’s gallbladder surgery. What about "average doctors" treating "average patients"?
2. **July 1, 2013**: "Excessive CT scans lead to 60% NHI claim rejections, with Taipei XX Hospital and XX Hospital facing over 90% rejection rates... In 2012, 1.5 million scans, plus MRIs and PET scans, cost 12.7 billion NT dollars annually." This means 60-90% of CT scans were unjustified. In the U.S., such hospitals (or doctors) would have been expelled from the insurance system long ago.
If this happens in Taipei, Taiwan’s most advanced city, imagine the situation elsewhere. Yet, our NHIA appears to turn a blind eye.What is even more alarming is that these hospitals have young student doctors. When senior doctors so casually dismiss the importance of "physical examinations" (i.e., the traditional Chinese medicine practices of observation, listening, questioning, and pulse-taking) and readily resort to expensive imaging tests, it becomes a case of "monkey see, monkey do." Young doctors mimic this behavior, learning only to prescribe tests during consultations, severely eroding the core values of medicine (Note: According to Wikipedia, radiation from CT scans can damage human cells and lead to cancer).
**February 27, 2013:** A hospital in Kaohsiung discards unused medication, recycling hundreds of kilograms monthly.
**November 22, 2013:** The amount of medication discarded annually in Taiwan, if stacked, would equal five Taipei 101 skyscrapers.
If these drugs are being thrown away by savvy patients because they are useless, imagine how many more useless medications are being consumed by patients who blindly trust their doctors.
According to a report by the "Drug Injury Relief Foundation," a multinational survey found that "Taiwanese consume seven times more medication than Americans. Even more concerning, in the U.S.—a country known for its strict medication standards—the daily death toll from improper drug use is equivalent to a Boeing 747 crash. Domestic pharmaceutical experts estimate that the hidden figures of disability and fatalities due to improper drug use in Taiwan may exceed those in the U.S. by more than sevenfold."
Who is prescribing these improper medications?
No wonder Taiwan has the highest rate of kidney disease in the world. So, who is responsible for prescribing these "improper medications"—the doctors or the patients themselves?
The wool comes from the sheep's back, and this year, the wool has been "successfully" sheared 3% more than last year. The medical industry's delight is understandable.
It is absolutely reasonable for the state to fund high-quality healthcare for its people. However, the author believes that if the National Health Insurance (NHI) authorities are indifferent, incompetent, or unable to curb waste—failing in their duty to protect (vulnerable and uninformed) citizens from the harms of "excessive medical treatment" and neglecting their responsibility to cut costs (eliminating malpractice while fostering benefits)—then they are no different from ancient bandits dividing spoils or modern-day fraudsters exploiting the NHI.
(The author is a physician in Taipei and the founder of the "Action Alliance for Chinese-Language Medical Records.")
Source: http:/ / mag. udn. com/ mag/ newss……torypage. jsp? f_ART_ID=539561