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.Many hospitals also spent the money on items unrelated to nursing, like banquets, trips, and clothing. It's sick.
“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.
Hence, the next time you're in a Taiwan hospital, be kind to the nurse. She's had a hard day.
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