Saturday, November 01, 2014

Health Care in Taiwan: a note on nurses

This chart from The Telegraph is making the rounds in the expat community here. It shows how Taiwan manages to have some of the world's cheapest, most affordable health care. We have a wonderful health care and health insurance system here. It is backed by a large research establishment that churns out paper after paper, along with numerous innovations, and excellent training programs for medical professionals that have a global reputation. I teach at one of the island's leading medical universities, and I also publish scholarly papers on nursing in Taiwan, so I have some small professional contact with the system. As a user, I can only say: it's wonderful.

However, like so many surprisingly affordable systems, it is based on exploitation. In Taiwan nurses must work overtime, but they only clock in eight hours at major hospitals around the nation. This abuse is winked at by regulators; without it the "system would collapse" (read: investors would extract fewer profits from the government subsidy program"). This abuse leads to many other abuses, which I plan to publish on someday when I no longer need employment at my university.

One of the most pernicious problems is the persistent shortage of nurses thanks to the crappy workloads and stagnant pay. The nursing situation is not different from other industries in this respect; Taiwanese bosses often treat workers like slaves, especially when their skin is too dark or they are of the wrong gender. This too is Taiwanese in another way: the success of the system depends on the exploitation and transmission of the fruits of female labor upward to the patriarch at the top. In any case this shortage dumps even more work on existing nurses, exacerbating turnover and leading to poorer patient care. The poorer patient care is partly masked because it is routine for families to move members into hospitals to care for their loved ones. This also holds health care costs down, a factor often missed when foreigners enthuse about the system.

Because of the brutality of this exploitation, many of my nursing students do not plan to become nurses. I have had innumerable conversations with my nursing students on the topic of "what to do now that I don't plan to become a nurse."

This situation lead eventually to public protests by nurses in recent years. I blogged on them in 2012...

After protests the government earmarked funds for increased nursing pay and to ease staff shortages and upgrade treatment. The Taipei Times reports on the totally predictable outcome...
Citing statistics compiled by the National Health Insurance Administration (NHIA), Taiwan Healthcare Reform Foundation researcher Lee Yun-ting (李芸婷) said that since 2009, the government has appropriated a total of NT$9.1 billion sourced from NHI income to hospitals nationwide in an effort to address the ever-worsening nurse shortage and nurse-patient ratios, including NT$2.5 billion last year and NT$2 billion this year.

“However, of the 492 hospitals and medical centers that received funding last year, only 49 percent actually used the money to hire more nurses or increase their incentives and overtime pay, with 14 percent failing to do so and 34 percent even reducing their nursing workforce,” Lee said.
Many hospitals also spent the money on items unrelated to nursing, like banquets, trips, and clothing. It's sick.

Hence, the next time you're in a Taiwan hospital, be kind to the nurse. She's had a hard day.
Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!


steve fenton said...

No greater advocate of the staff than me having had far too much experience

STOP Ma said...

My niece is becoming a nurse in Taiwan, so thanks for the info (as depressing as it is).

My experience with the Taiwan Health system has been mixed. When it comes to a specific private Hospital (Chang Gung), I was absolutely appalled at how they treat their patients. We almost filed a lawsuit against them. And it wasn't just one instance, either. The "quality of care", in these experiences, was quite dreadful.

Granted this is anecdotal and the overall stats may say otherwise, but I am hesitant in putting Taiwan healthcare on such a high pedestal.

Mike Fagan said...

I have had the same conversations, plus many conversations with current nurses who make the same complaints: 12+hour shifts every day for NT$30,000 a month. But it is difficult for them to quit because they worry about the additional workload that would place on their colleagues.

Good post.

Anonymous said...

I was working in Taiwan as a RN 25 years ago, shocking to hear the system doesn't change at all. It is so sad the nurse leaders did not do anything to promote the social status and advocate for the bedside nurses. There are many ways can help Taiwanese to improve the local employment and improve the nurses shortage, as long as Taiwan government would change the health system and cut the cost.

I've never understood why the "knowledge workers" like RNs functions are writing lab scripts, prescriptions for physicians, doing all the paper works or take patients to different departments, those jobs don't require special nursing training. Preparing and passing medication whole day, also get ready the lab tube for blood work.... They don't have time to asses patients or show what they can do in their profession.

People in Taiwan need to change their mentality too, nurses are not MAIDS. If government, Politian and community won't change their attitude, won't be too long, Taiwanese will face the biggest crisis-bring you own nurse if you are sick or someone who doesn't speak Chinese or understand the culture will be your "nurse".
I don't even need to mention what kind of quality of care you will receive?