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Taiwan's health care system is one of the best in the world in terms of convenience, freedom of choice, affordability, efficiency and patient satisfaction. It's a great achievement that Taiwan can be proud of. While its health insurance expenditures account for only 5 percent of GDP, far below the United States'12, Germany's 10 and Japan's 7 percent. It makes people wonder how these superior yet cost effective services can be achieved. However, many unfortunate details underlying this seemingly perfect system are mostly ignored. The author has operated a local hospital for more than 16 years, and has witnessed the ever-increasing strains placed on management and medical staffs, but there is seldom public expression of these frustrations. This report will collect the opinions of medical personnel throughout the country and analyze the pressures on the medical community scientifically. Thus the ultimate goals of this research is to expose the pressures of hospital management in Taiwan, to analyze how hospitals of varying grades handle these pressures, to investigate the causes of mass closures among local hospitals, and to present possible solutions to this situation.
This study was divided into three stages. The first stage consisted of in-depth interviews with 11 experts including presidents, vice presidents and top executives from hospitals of all grades to compile the possible sources of pressure faced by medical communities. The second stage involved conducting surveys with questionnaires by the 11 aforementioned experts. This study covered a total of three levels with 30 pressure factors. Using AHP-level analysis, the main findings showed that business pressures originating from the "external environment" were higher than those from the “internal environment”. External environmental factors such as the "National Health Insurance policy" and "Hospital Accreditation" were ranked the first and the second place, while internal environmental factors such as "financial pressure" and "medical disputes" were ranked the third and the fourth. The third stage was a national survey of all the hospitals operating in the country with the questionnaires which originated from above 30 pressure factors. They utilized the Likert 7 scale to analyze the responses toward management stress. This survey was sent to 482 hospitals operating in the country. Two hundred eighty valid questionnaires were recovered, a response rate of 58.1%. Utilizing the statistical software SPSS, along with the the weight conversion operation derived from the second stage. The hospital system was categorized into three distinct groups, the "Medical center", "Regional hospital" and "Local hospital". Through adopted multi-variable analysis, results revealed that the scores of "financial pressure"、"medical manpower"、"quality of medical care"、"competitors", and "the law stands" in the "Medical center" group were significantly lower compared to the other 2 groups. Scores of "Hospital Accreditation"、"medical disputes" and "Global budget" / "Deduction rate of claims" under the "National Health Insurance policy" were not significantly different in all of the three-grade hospitals, but the average scores of the pressure factors indicated all hospitals were experiencing tremendous pressure. When hospitals were reclassified into two groups: private-owned local hospitals vs. other hospitals, the T-test revealed that in addition to the above-mentioned pressure factors, the categories of "financial pressure"、"medical manpower"、"quality of medical care" and "competitors" in private local hospitals were also tremendous. The fact indirectly explained why a large number of private local hospitals had gone out of business.
In conclusion, the management pressures tops on local hospitals which are vulnerable during these current unfavorable circumstances. If the government can grant the proper assistance in time, the rate of hospitals closing down will be slowed, and a quick and effective medical care system can be maintained. On the other hand, the local hospitals should strengthen their competitiveness, make the best use of support physician systems to ease the load on manpower, to locate clear on their function, avoid unnecessary facility purchases, to collaborate with medical centers and put a two-way referral system into effect. The government may adjust the national health insurance fee to a graded structure. ‘The National "Health" Insurance’ should be renamed ‘The National "Disease" Insurance’. People manage their own "health", whereas the government only involve in treatment of serious illness. If the "adult health examination" and "child health examination" were assigned to the local hospitals, medical centers and regional hospitals could focus on severe and emergency medical care. Moreover, the NHI should cover the expenses of medical disputes by seting up an independent fund. Facilitate media institutions to introduce local medical resources, let the people get a clear picture of local hospitals and make use of, so they will save the travelling time and expenses to the medical center. If the problems of local hospital resolved, all the pressures to be readily solved！
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