Taiwan: A Stronger Healthcare Partner

Taiwan Review, 1 juni 2011
Författare: Kelly Her
http://taiwanreview.nat.gov.tw/ct.asp?ctNode=1446&xItem=167074&mp=1

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Taiwan is striving to contribute to world health while consolidating its existing healthcare system.

“I feel very lucky to be able to come to Taiwan to receive surgery. I want to thank all of the medical staff at Chang Gung Memorial Hospital who helped me get my chin and teeth back. Now, I can not only chew, but I’ve also stopped drooling,” said the 21-year-old Romanian girl, identified only as Cristina, with a big smile on her face. She expressed her heartfelt gratitude at a press conference on April 18 this year before returning to her home country.

The press conference came at the end of three visits Cristina made to Chang Gung, located in Taoyuan County, northern Taiwan, for reconstructive surgery, starting in April 2010. The young woman had sustained serious injuries in a car accident in Romania in May 2009 that smashed her mouth and chin. She had undergone two unsuccessful operations in her home country.

Thanks to a referral from the Dallas, Texas-based World Craniofacial Foundation, Cristina was put in touch with Chang Gung, where over a period of one year a surgical team led by Lin Chih-hung rebuilt the young woman’s chin using bone grafts from her lower leg, implanted teeth into her lower jaw and completed repair work to her chin and lower lip so that her mouth could close. The team included specialists from the hospital’s craniofacial, general plastic surgery, trauma, dental, oral surgery, reconstructive microsurgery and nursing departments.

One of the first visits the young Romanian made after securing the all clear from doctors was to a local convenience store to buy a hot dog, a solid food item that she had missed since her facial injuries had forced her to rely on liquid food.

With a widespread reputation for expertise in plastic and reconstructive surgery, Chang Gung annually treats more than 800 patients with craniofacial pathologies and injuries from home and abroad as well as performs more than 1,000 cases of reconstructive microsurgery every year, with success rates topping 98 percent.

Romanian patient Cristina, who received three rounds of reconstructive surgery at Chang Gung. The surgeries helped to restore her chin and the ability to chew. (Photo Courtesy of Chang Gung Memorial Hospital)

Since its establishment in 1976, Chang Gung has expanded to become one of the island’s largest medical centers with a service network that includes its headquarters in Taoyuan, five branches across the island and some 3,700 medical personnel. The hospital serves an average of 7.5 million outpatients and 276,000 inpatients each year and has trained more than 1,000 doctors from around 10 countries, mainly from India, Hong Kong, the United States, Korea and the Philippines, in addition to sending doctors and nurses overseas regularly to render charitable medical services.

World-Class Expertise

Sue Huei-cheng, executive administrator of Chang Gung’s Administration Center, says that over the years, his hospital has accumulated particular expertise in the fields of plastic and reconstructive surgery, liver and stem cell transplants and neurosurgery. The one- and five-year recipient survival rates of the living donor liver transplants performed at the hospital, for example, stand at 95 percent and 91 percent respectively, which are among the highest in the world.

“Taiwan’s current medical quality is comparable to and competitive with that of industrially advanced countries and at much lower costs. We’ve developed several medical techniques that lead not only in Asia, but also the world,” Sue says. “Now that we have these abilities and resources, we’re trying to provide medical care across nationalities and national boundaries to benefit more people in need.”

With that in mind, Chang Gung set up the International Service Center in 2007 with English-speaking staff members. One of the services provided by the center is to offer phone consultations to people living outside Taiwan who intend to travel to Chang Gung for treatment. The center’s staff provides estimates of related expenses, information on travel and accommodation, as well as help with completing registration forms and making appointments with doctors.

Sue believes that Taiwan’s high-quality medical care deserves international publicity. He suggests the launch of more promotional campaigns through the Republic of China’s (ROC) embassies and representative offices as well as branch offices of the Taiwan External Trade Development Council (TAITRA) around the world, or possibly the establishment of a dedicated authority.

With regard to international patients, in addition to the active promotion of medical travel for the treatment of serious injuries or illnesses, a number of medical institutes in Taiwan are focusing on medical tourism that includes health checkups or aesthetic medicine. Shin Kong Wu Ho-su Memorial Hospital, located in Shilin District, Taipei City is one such establishment. The hospital runs the Shin Kong Medical Club, a service dedicated to international medical travelers.

Chen Yu-ray, left, a doctor at the Chang Gung Craniofacial Center, instructs two foreign physician interns. The hospital has trained more than 1,000 doctors from some10 countries. (Photo Courtesy of Chang Gung Memorial Hospital)

Alex Hung, president of Shin Kong Medical Club, says that compared with its neighboring countries, Taiwan’s medical services are not the cheapest, but are nevertheless very affordable and good value. The main weakness, he says, is the English-language ability of staff in the sector compared with counterparts in Singapore and Thailand. Hence, Hung believes that Taiwan has a better chance of success by targeting Chinese-speaking patients, in particular well-to-do mainland Chinese, given the language and cultural similarities, geographical proximity and Taiwan’s higher quality of medical services.

A Fraction of the Cost

“Currently, many countries, particularly those in Asia, are gearing up efforts to develop medical tourism, which has huge business opportunities and growth potential,” Hung says. “Compared with Singapore and Hong Kong, Taiwan’s medical costs are at least two-thirds lower on average. And compared with Japan and Korea, Taiwan has the language advantage when soliciting Chinese patients.”

To cater to rising demand for health management and preventive medicine among members of the general public, Shin Kong has set up a premium health examination center to offer an array of services using state-of-the-art equipment including 256-slice computerized tomography (CT), positron emission tomography (PET/CT) and magnetic resonance imaging (MRI).

“The PET/CT, MRI and CT systems can allow early screening of the three most common illnesses—cancer, cerebrovascular diseases [such as stroke] and cardiovascular diseases [resulting in myocardial infarction, for example],” Hung explains. “They are non-invasive, low-risk procedures that can effectively diagnose small tumors or abnormal symptoms.”

Shin Kong, a DOH-accredited medical center, has thus far conducted more than 25,000 PET/CT examinations since 2001. Hung says the average age of patients is 55 years old and 1.2 percent of those examined are found to have cancer.

Chang Gung treats an average of 276,000 inpatients as well as 7.5 million outpatients each year. (Photo Courtesy of Chang Gung Memorial Hospital)

Hung’s medical club began cooperating with a local travel agency in 2009 to plan various four- to six-day packages that combine a half-day health examination followed by a healthy meal and recreation options including visits to a hot spring and spa resort and sightseeing around Taipei at a charge of NT$60,000–$80,000 (US$2,070–$2,760).

Cross-Strait Potential

The club president says that more than 700 mainland visitors have participated in the health tours and that they are now the main targets for Shin Kong in its promotion of medical tourism. The strategy was made possible by the government’s mainland policy that encourages cross-strait exchanges and has seen the opening of direct transportation links with mainland China since late 2008.

So far, the visitors have responded well to the services offered by Shin Kong. For example, in a recent survey conducted by the medical club, mainland Chinese visitors praised the hospital’s environment and facilities. “It’s amazing that your hospital has only the aroma of coffee and no sharp smell of drugs,” wrote one respondent. “No hospital in our hometown has a 256-slice CT machine. Receiving such high-tech examinations here will be something that I can boast of when I get back home,” wrote another. “Your hospital’s cleanliness and tranquility compared with the crowdedness and tumult of the mainland’s hospitals is impressive,” wrote a third.

Still, Hung says the number of Chinese mainlanders that have signed up for health tours is below his expectations. He suggests further relaxation of regulations governing mainland Chinese visa applications for entry into Taiwan and issuing medical visas to foreign visitors seeking treatment.

Shih Chung-liang, director-general of the Bureau of Medical Affairs under the Department of Health (DOH), says that when it comes to medical care, one of Taiwan’s major advantages is its pool of talented medical personnel. Domestic medical schools usually can choose from among the students with the best academic performances, Shih says, and they provide solid, seven-year educational programs.

A mainland Chinese tourist undergoes a high-tech PET/CT examination at Shin Kong. (Photo Courtesy of Shin Kong Medical Club)

In recent years, mainland China and Singapore, for instance, have shown keen interest in recruiting Taiwan’s medical workers, especially those with expertise in hospital management, by offering contracts with lucrative remuneration. There are also investment incentives for setting up hospitals in those countries. In fact, the exodus of medical talent has the potential to turn into a crisis for Taiwan, Shih notes. Moreover, the strict payment system implemented by the National Health Insurance (NHI) program has led to substantially smaller profits for domestic hospitals, which consequently limits their abilities to raise wages for their employees. This situation is likely to aggravate the problem of talent outflow, the director-general adds.

Hence, the promotion of Taiwan’s medical services to people from overseas is an imperative task that can add another source of income for domestic hospitals, Shih says. That will put them in a stronger position to retain talented staff members as well as improve their facilities and services, he says, a situation that will benefit local residents as well.

The government has also planned to set aside a number of designated areas for offering international medical services. The move is designed to combine medical and tourism resources to offer convenience and efficiency to medical travelers. It also comes partly in response to concerns that international patients could impinge on local residents’ access to medical care in the regular hospital system. The sites are likely to be situated in Taoyuan County in the north, Kaohsiung City in the south and the outlying island of Kinmen and will accommodate not only medical facilities but also shopping malls, tourist hotels and exhibition halls under the build-operate-transfer model.

Meanwhile, Shih says besides having relaxed the rules governing medical advertising, the DOH has coordinated with the Ministry of Foreign Affairs and the National Immigration Agency to streamline the visa application procedures for foreigners and mainland Chinese who intend to seek medical treatment in Taiwan.

Shin Kong Medical Club cooperates with SweetMe Hotspring Resort located in Taipei City’s Beitou District to offer relaxing spa services as part of the club’s health tours. (Photo Courtesy of Shin Kong Medical Club)

In addition, the DOH has entrusted the Taiwan Nongovern­mental Hospitals and Clinics Association (TNHCA) to form a special task force to promote Taiwan’s medical services internationally. Wu Ming-yen, executive director of the TNHCA, says for the time being, his organization works with 33 regional hospitals and medical centers across the island to participate in the international medical service scheme and offers a consulting service to help them establish standard operating procedures for receiving foreign patients, prepare English documents and improve the quality of their services and facilities.

As for international marketing, the TNHCA-formed task force has set up a website, www.medicaltravel.org.tw, that gives information on medical services, hospital admission procedures, estimated costs and travel in traditional Chinese, simplified Chinese, English and Vietnamese. It has established contact points in about 10 countries to provide information on Taiwan’s medical services and referral services through cooperation with local insurance companies, clinics and travel agencies. The association also worked with the author of Patients Beyond Borders, Josef Woodman, to create a Taiwan edition of the medical travel guide. The book was released in 2008 in the United States.

Moreover, the task force has worked with several international media organizations including Reader’s Digest and National Geographic Channel to facilitate their coverage of the characteristics of Taiwan’s healthcare sector. Reader’s Digest published an article in 2009, while a film from National Geographic Channel is scheduled for release later this year.

“Taiwan is well positioned to promote medical travel and medical tourism given its quality services and price advantage,” the executive director continues. “In general, Taiwan’s medical cost is about one-fifth of that in the United States.”

Wu attributes Taiwan’s medical progress to its implementation of a hospital accreditation system since 1986 that examines three domains—administration, medicine and nursing—evaluating more than 500 criteria that range from management to patient safety and comfort. The evaluations are performed every three years and hospitals that obtain accreditation can claim increased government funding. Taiwan was the world’s fourth country (behind the United States, Canada and Australia) and Asia’s first to launch such a mechanism.

Competition, Quality

Volunteer workers of Taiwan Root Medical Peace Corps, a nongovernmental organization, attend to Haitian residents in 2010 after the country was hit by a massive earthquake. (Photo Courtesy of Taiwan Root Medical Peace Corps)

About 70 percent of hospitals in Taiwan are privately run, which Wu says is the optimum ratio of public-private services to provide high-quality care. He believes that the competition among medical providers ensures that only hospitals offering good services will survive in the hotly contested sector. In fact, Wu says mainland China and several Southeast Asian countries, where hospitals are mostly public establishments, are seeking structural reforms in order to pursue similar privatization schemes.

On another front, Wu concurs with the thoughts of executive administrator Sue Huei-cheng of Chang Gung on Taiwan’s competence in promoting the flow of patients and healthcare services and professionals across national borders. “Thirty years ago many Taiwanese doctors went to the United States to receive training, but now [local doctors] have the ability to demonstrate their skill and give instruction abroad,” Wu says. “And besides successfully eliminating diseases such as cholera, polio and malaria, Taiwan’s NHI program, which was launched in 1995 and now covers as much as 99 percent of Taiwanese, has won international acclaim.” Taiwan’s NHI was featured in the documentary Sick Around the World as part of the Frontline series by the US Public Broadcasting System in 2008. The Taiwan system was considered a successful model in the US healthcare reform debate between 2009 and 2010.

“Over the years, Taiwan has cultivated substantial knowhow in medical technologies, hospital management and the establishment of its NHI system, as well as organized numerous international medical missions to render disaster relief and humanitarian aid,” Wu says. “Taiwan is capable and eager to contribute its medical resources and expertise to the international community more effectively and strengthen its role as a global health partner.”