Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
2011-06-30 China Times
By Chiu Li-ying and Chang Tsui-fen / Taipei Report
The Bureau of National Health Insurance (BNHI) released statistics yesterday, showing that 1,126 people in Taiwan used extracorporeal membrane oxygenation (ECMO) last year, with 499 surviving. The total medical expenditure reached NT$900 million. Dr. Ko Wen-je, director of the Trauma Department at National Taiwan University Hospital, questioned the excessive and inappropriate use of ECMO in Taiwan.
Ko noted that the U.S. population is 13 times that of Taiwan, yet over the past 20 years, ECMO has been used approximately 40,000 times there, averaging about 2,000 cases per year—only twice Taiwan’s usage. This indicates Taiwan’s ECMO utilization rate is indeed disproportionately high.
According to the BNHI, ECMO patients last year were hospitalized for an average of 22.51 days, but the actual ECMO usage averaged 4.25 days, with the longest case lasting 64 days. The average total medical cost per ECMO patient was about NT$790,000, of which nearly NT$150,000 was for ECMO expenses, accounting for 20% of the total medical costs. The survival rate for ECMO patients was close to 50%. Half of the users were in cardiac surgery and internal medicine, followed by general surgery. Medical centers accounted for 65% of ECMO usage.
Ko Wen-je, a leading authority on ECMO in Taiwan and director of the Trauma Department at NTU Hospital, expressed skepticism. He pointed out that while NTU Hospital’s ECMO survival rate is 49%, the average usage duration is 9.25 days. In other words, higher survival rates should correlate with longer average usage times. However, the BNHI’s statistics show an average ECMO usage of just four days with a 44% survival rate, which he finds "highly unusual."
Many families place excessive expectations on ECMO, Ko said. "What’s the point if the patient survives but becomes vegetative or passes away shortly after?" He emphasized that Taiwan’s annual ECMO usage exceeds 1,000 cases, costing the NHI nearly NT$1 billion—not including out-of-pocket expenses, nursing costs, and the emotional and physical burden on families. The BNHI should disclose the one-year survival rate post-ECMO to better assess its effectiveness and review when it should or shouldn’t be used.
Source: http://life. chinatimes. com/ life/ 100302/ 112011063000063. html
NHI Spends 900 Million to Save 499 Lives: Ko Wen-je Criticizes ECMO Abuse
By Chiu Li-ying and Chang Tsui-fen / Taipei Report
The Bureau of National Health Insurance (BNHI) released statistics yesterday, showing that 1,126 people in Taiwan used extracorporeal membrane oxygenation (ECMO) last year, with 499 surviving. The total medical expenditure reached NT$900 million. Dr. Ko Wen-je, director of the Trauma Department at National Taiwan University Hospital, questioned the excessive and inappropriate use of ECMO in Taiwan.
Ko noted that the U.S. population is 13 times that of Taiwan, yet over the past 20 years, ECMO has been used approximately 40,000 times there, averaging about 2,000 cases per year—only twice Taiwan’s usage. This indicates Taiwan’s ECMO utilization rate is indeed disproportionately high.
According to the BNHI, ECMO patients last year were hospitalized for an average of 22.51 days, but the actual ECMO usage averaged 4.25 days, with the longest case lasting 64 days. The average total medical cost per ECMO patient was about NT$790,000, of which nearly NT$150,000 was for ECMO expenses, accounting for 20% of the total medical costs. The survival rate for ECMO patients was close to 50%. Half of the users were in cardiac surgery and internal medicine, followed by general surgery. Medical centers accounted for 65% of ECMO usage.
Ko Wen-je, a leading authority on ECMO in Taiwan and director of the Trauma Department at NTU Hospital, expressed skepticism. He pointed out that while NTU Hospital’s ECMO survival rate is 49%, the average usage duration is 9.25 days. In other words, higher survival rates should correlate with longer average usage times. However, the BNHI’s statistics show an average ECMO usage of just four days with a 44% survival rate, which he finds "highly unusual."
Many families place excessive expectations on ECMO, Ko said. "What’s the point if the patient survives but becomes vegetative or passes away shortly after?" He emphasized that Taiwan’s annual ECMO usage exceeds 1,000 cases, costing the NHI nearly NT$1 billion—not including out-of-pocket expenses, nursing costs, and the emotional and physical burden on families. The BNHI should disclose the one-year survival rate post-ECMO to better assess its effectiveness and review when it should or shouldn’t be used.
Source: http://life. chinatimes. com/ life/ 100302/ 112011063000063. html