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.
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[Taiwan] 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!

CNN iReport on Taiwan's Nurses

A Taiwan nurse speaks out on CNN:

When all of the medical workers in an unhealthy working environment, the patient must to facing a high risk care quality, because in Taiwan, every nurse should take care of at least eight patients in morning shift, even more. Over twelve patients in afternoon shift and almost take care of nearly twenty patients in night shift! That’s pretty incredible.

Nurses in Taiwan are not only superwomen or supermen, but are also patients. Staff shortages happened in past ten years, the trickiest thing is that Nurses do not have right to sick anymore, only because of nurses shortages. Taiwan's hospitals manager will not let their nurse get a sick leave if the nurse still able to walk even in public hospital system.

The Nurse’s working hour in Taiwan often over ten hours every shift, even more. However, the hospital did not give overtime fee; they only give nurses unreasonable pay to buy their break off. The medical environment of the culprit was created by the National Health Insurance System.

The emoting here is offputting, but the information is correct, as I noted in the post a few posts below this one. It would have been great if she had found a native speaker to edit it properly. But it would have been even better if she had identified the real culprit: the fact that many hospitals are essentially for-profit concerns that run by farming the government subsidy, and thus, nurses represent costly labor rather than profit centers. Taiwan institutions, whether public or private, health or manufacturing, all treat labor the same way. The real issue is not the NHI but that in Taiwan a nurse is like most laborers, without a real union.
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Daily Links:

• Taiwan LED maker moves factory back to Taiwan. Some interesting quotes in here....
• Growth forecast slips again.
• Gov't once again loses sanity on the Senkakus. Taiwan's crazy claims on the South China Sea and on Japanese territory hurt its ability to cooperate with neighbors.
• Stores to lock up charcoal to prevent suicides? It won't work. I wrote on the charcoal/suicide issue five years ago, still relevant. 

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[Taiwan] 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! Delenda est, baby.

Nursing a Grievance

This is a video of 500 nurses holding a meeting to complain about conditions at Taipei's Rungzung Hospital, a situation replicated all over Taiwan. The hospital was successful in keeping the media out of the meeting so this video comes from the cellphone of a participant.

According to the video, the hospital is short 171 nurses, and thus each of its nurses care for too many patients. Rungzung is famous; it has a 95% occupancy rate. The nursing shortage is paradoxical -- there are more nursing students then places for them, but then they leave the profession at greater rates than they enter when they realize how awful it is. At some hospitals the nurses clock out at the end of the shift as required by law but then work unpaid and unrecorded overtime, exploitative, illegal, and dangerous.

This is not a health industry problem but is par for the course in all sorts of production situations in Taiwan, especially where there is a moral or public service element involved (the police also have brutal schedules) but in general workers in offices and factories who work overtime without pay don't kill people when they make inevitable errors. These problems are only the tip of the iceberg, I hope to do some interviews of nurses before the summer and expand the list of issues. What I've already heard will make your hair turn white.

The first nurse to rise complains that they make $30,000 month as a nurse; on her recent trip to a Taichung night market she encountered a student worker making $33,000 a month selling fried octopus meatballs in the night market. "Shouldn't I go sell octopus balls in the night market?" she says, to everyone's laughter and resounding "yes!" Then she goes on: "those of you who have been here three years, four years, have you been promoted?" "No!" The next woman who stands up complains that the money the hospital has been spending on purchasing flowers to beautify the place should be going to paying the nurses.

Because it is doctors who generate income for the hospital by taking on patients, hospitals seek to maximize doctors and minimize nurses, who represent a cost to the institution, which are often privately owned and like so many large corporations in Taiwan, farming Taiwan's subsidy regime. At the bottom of the institutional pecking order, often from working class families, nurses are the target of the System's attempt to reduce costs by exploiting labor. The job is so awful that even nursing positions that pay as much as college professor positions go unfilled.....

Clearly reforming the NHI is going to involve much more than simply adjusting the billing and payment regimes. The whole approach to the use of labor is going to have to be rethought.
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[Taiwan] 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! Delenda est, baby.