National Health Insurance reform: The problem and analyis of healthcare services and management

Project Investigator : Shou-Hsia Cheng 

 

        The implementation of national health insurance program (NHI) in 1995 in Taiwan has significant impacts on health care delivery. People's access to healthcare has been improved; the inequality in health between various sub-groups has been reduced. Nevertheless, the distribution of medical specialists might remain unsatisfactory although the total number of doctors has increased to an acceptable level according to the government's health manpower plan. A recent report by Mr. Huang from the Control Yuan indicated that there is deficiency in major medical specialists such as internal medicine, surgery, Obstetrician/Gynecologist and pediatrics. This issue has become an important topic to the public and for the health authority.

        The shortage in the 4 major medical specialties can be interpreted via various view-points. The medical society emphasizes that medical students are no longer interested in those specialties that can save lives because the training tends to be very hard and the practice is more likely to incur lawsuit. The government officials consider that there is no shortage in those major specialties concerning the quantity of doctors currently practicing according to the registration files. The academic researchers revealed that the lack of “new doctors” in certain specialties might be due to the decreased demand for services, for example the dramatic decrease in the number of new born babies results in reduced demand for pediatric care services in the past 10 years or so. These view-points revealed the various perspectives of this “doctor shortage” problem.

        This study intends to clarify the problem from various perspectives and to propose possible solutions to the problem. This study will conduct comprehensive data gathering concerning the statistics of medical manpower in certain specialties and analyze the healthcare services utilization in the past years by using the NHI claim data. Two questionnaire surveys will be carried out; one is for the general public to understand their perception of the “doctor shortage” problem in their resident area, the other is for medical students to understand their preference in choosing a specialty in the future. Finally, in-depth interviews with key persons will be conducted and symposium meetings will be held to clarify various view-points from medical doctors, health authorities, and academic scholars, concerning the possible causes of problem and to reach a consensus on possible solutions.