Taiwan's Public Health System...Musings

Sometimes, there are those discussions with my private students that make this job an incredibly underrated one. Often, I feel as though I'm allowed to interview different representatives from different parts of Taiwanese society... while getting paid for it. It really is a wonderful experience, teaching, that is - particularly days like today, where we're not too overworked so as to enjoy it.

This afternoon I had a fascinating one hour 'interview' with one of my private students, a Medical History professional who specializes in the development of Taiwan's public health system over the 20th Century. We discussed a range of issues, both problematic and systemic, within Taiwan's public health structure and its development throughout the course of Taiwan's colonial and post-colonial periods. A discussion which began with the simple, "How was work?"

Before I explain, I really should state the 'health' is a subject that I've discussed widely in both my intermediate and advanced level English classes. It seems to me that there is a general consensus that Taiwan's health system is extremely convenient, so too the Health Insurance Program. (A government-subsidized program similar to Medicare, but with a wider range of benefits, including dental.) It goes without saying that Taiwan's public health system far exceeds the quality of anything I saw in China, and in some ways, perhaps rivals Australia.

However, some of my students seem to believe that the doctors in Taiwan (particularly those based in hospitals) have little time to make in-depth diagnoses; and fear that perhaps the quality is diminished in that regard.

My student and I began by discussing an increasingly common practice here in Taiwan; a practice whereby doctors (even medical interns) falsify medical records, ultimately making a diagnosis without the relevant examinations/test results. It's her belief that despite sworn hippocratic oaths, that doctors are so overworked that they result to such methods; essentially guessing what a patient is suffering from.

It's her view that Taiwan's medical professionals in recent decades have sought to replicate, respectively, both the American/English public health systems; notably, their focus on utilizing business/economic principles to motivate its employees. I was absolutely astonished to find out most GPs are on commission-based government salaries. In my mind, commission rates apply to vacuum-cleaner salesmen and call-centres, not public health specialists! My student emphasized that there would be a drastic difference in annual income if a doctor were able to minimize their time with each patient. Ultimately, these are economic principles attached to the most fundamental elements of civil society. How can one expect that doctors would not be swayed into opportunizing their hippocratic duties if there were offered significant economic incentives to do so?

Likewise, I brought up with my student a conversation that I had in recent days with another of my advanced students, who is training to be a nurse. While we were discussing her studies, it came up that she planned to move to the U.S. upon graduating, claiming that not only are nurses paid extremely poorly here in Taiwan, but there positions are far from venerated; a kind of "if you're so clever, then why aren't you a doctor?" approach.

I brought up this up with my student this evening, and her response was fascinating. She completely agreed that this status problem for nurses is widely held in Taiwan. In fact, so too do university entrance examinations reflect this common perception, with medicine, Chinese medicine, pharmaceuticals, and rehabilitation entrance scores far higher than those of nursing.

It's her belief that this status quo is derived from the colonial era under Japan, whereby this perception of public health professionals was carried from Japan into Taiwan. Midwives, in fact, were seen as far more worthy health professionals, and received a high level of certification and training support from the Japanese government. In fact, it wasn't until the late 1950s that the first institute for nursing was opened in Taipei.

According to my student, during the colonial era, public health was seen as an act of colonization, that is, a way to civilise the local Taiwanese people by the Japanese. Education was held in similar steed (though I won't get into that at the moment). By training public health professionals, the Japanese were able to successfully use health as both a practical necessity and a form of social advocacy, sending their message of what civilised good health should be across the face of Taiwan. In this regard, I understand fully how my student sees this to be the most critical period of change in the history of Taiwan's health system.

These trained midwives were able to successfully interact with the local Taiwanese communities to spread their message of "good health" during the colonial period. The health professionals would often work closely with the baojia of Taiwan, that is, local community/village leaders. By doing so, they were able to ensure that the Japanese governments' public health message was effectively communicated across the country.

It's fascinating, isn't it - that drastic change, if delivered through well-established channels, can be made palatable and therefore exeedingly effective...

Sometimes this job is just such an experience.

LG