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Sicko in Taiwan

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Last year I wrote a post about Taiwan’s National Health Insurance program, having found a thoughtful article about the costs and benefits of Taiwan’s system. Now it seems that Taiwan’s system is getting even more attention, this time from a new PBS TV series: “Sick Around the World.” (All episodes of Frontline are available for free online viewing via the website!) Jonathan Cohn reviews the show and talks about health care in Taiwan:

The most interesting case study is probably Taiwan. A few years ago, when Taiwan decided to revamp its health care system, it studied other countries to determine which system might work best. Its conclusion? A single-payer system–one in which the government insures everybody directly–made the most sense.

Virtually alone among health care commentators in the U.S.–a category that includes me–Paul Krugman has been touting Taiwan for a while. The film makes it easy to see why. Today, the people of Taiwan have guaranteed access to health care–and, according to the film, it’s very good health care. There are no chronic waiting lists, like you find in Britain, and the care is very advanced. Among other things, Taiwan is among the world leaders in establishing electronic medical records–an innovation that should significantly improve care by keeping doctors and nurses better informed about patient histories and, no less important, avoiding potentially dangerous drug interactions.

Reid and Palfreman note, rightly, that the Taiwanese system isn’t as foreign as it seems: We actually have a similar program here in the U.S.–for the elderly. It’s called Medicare.

Now, over the past six months I’ve gotten to know Taiwan’s health care system better than I would have liked (don’t worry – everyone’s OK), and I have a pretty good sense of the good and the bad. The good is that one can go see any specialist just by showing up at the hospital and registering for an appointment. Its dirt cheap and you can see as many doctors and specialists as you like until you find something that works. The doctors are willing to do endless amounts of tests, and they dispense medicine generously (OK, that’s actually one of the bad things – but sometimes plenty of cheap meds is a plus). I’d say that the hospitals and doctors are all well trained and highly professional – even out here in the countryside.

On the other hand doctors here seem to see way too many patients in a day – far too many to give each one the time and care they need. Also, doctors rarely seem to talk to each other across specialties, and there is no framework for hospitals to share patient records unless you get the file out yourself and bring it to the other hospital. Doctors are used to assuming authority and don’t like being questioned and discourage second opinions. But when I think about these problems I don’t think they are unique to Taiwan. I think they are general problems with modern medicine – and don’t reflect on the benefits which come from having a single-payer system.

I have a relative who is a doctor in the US. He had a Taiwanese patient with leukemia. He told her to go home to Taiwan because he felt she would get better treatment there than in the US. She did, and she got better. I don’t know the facts of the case, but I’m sure the costs in Taiwan were quite manageable. I’ve paid no more than a couple of hundred dollars here for procedures which in the US would have cost thousands.

I’ve heard a lot of people from Canada, England, and Taiwan complain about their health care systems, and criticize those who paint too rosy a picture. Sure, but I think they grossly underestimate just how much worse the US is. Even if we are generous and assume that the systems are roughly comparable, Americans pay nearly twice as much as these other countries for care which is certainly no better, and possibly much worse. Few of the people who have said such things to me have actually watched Sicko. If you haven’t, I recommend that you do.

UPDATE: There was also this report on NPR:

To satisfy the patients in Taiwan, there’s no gatekeeper who controls access to specialists and no waiting lines.

If you woke up in Taiwan with shoulder pain, for example, Chang says that you would be able to see an orthopedic specialist the same morning, no recommendation from a general practitioner required.

“Our people don’t like the idea of gatekeepers. They want to decide by themselves,” Chang says.

Don’t Forget Your Smart Card

By consolidating so much — one government plan that covers everybody — Taiwan achieves remarkable efficiency.

Everybody here has to have a smart card to go to the doctor. The doctor puts it in a reader and the patient’s history and medications all show up on the screen. The bill goes directly to the government insurance office and is paid automatically.

So Taiwan has the lowest administrative costs in world: less than 2 percent.