It is exemplary that Taiwan looked beyond its borders for answers. I feel like this is a logical and good thing to do. We should look at what other countries are doing, and address if their methods are working and assess why or why not? The fact that Taiwan did this demonstrates the county's willingness to adopt change and to adopt nontraditional methods if they resulted in an effective health care system that made the health of citizens a priority.
If I had to suggest one thing for a health care system to adopt it would be more public health measures. Perhaps I am biased, but I strongly believe that in adopting more public health measures, the health care system shifts from a system that is predominantly curative to one that is highly preventive. This is fundamental because if diseases and conditions are being prevented all-together or being caught at an earlier stage, the population of that nation will have better overall health and will hence be more productive and successful. Additionally, this will drive down costs in the medical field, making it a win-win situation for both the people as a whole and the government. I believe places like the U.K are doing a good job by providing incentives for doctors to keep their patients healthy. This is a great way to implement more public health into the system.
Tuesday, November 24, 2009
Much to learn
I think we all agree that it makes sense to look at the things that have worked for other systmes and try to incorporate them into our own system, instead of re-inventing the wheel every time. However, there is no perfect system, and every country has fundamental differences in the attitudes of the people, the politics, the finances and the social agenda.
Of all the reform ideas, the one I think would be most acceptable and have the highest impact in the US is to have a committee that reviews the cost-benefit and scientific data supporting various treatments (such as the NICE committee in the UK), and have government subsidies for those treatments. We already have a functional system like that, in that Medicare coverage drives the insurance reimbursements for almost all medical services. Furthermore, the US government makes recommendations about acceptable screening practices through the US Preventative Services Task Force and treatement practices through the CDC. However, even these are not without controversy. The USPTSF just published new guidelines on Mammography which have NOT been accepted by the American Cancer Society, the American College of Obstetrics and Gynecology or the American Medical Association, despite being based on the evidence.
The other idea that might work here is to go to a computer based medical record system. The opposition has a clear argument around personal privacy, however our country has been quick to embrace the mobile media, and would quickly realize the benefits of a uniform, easily accessible medical record, much like they have in Taiwan.
Of all the reform ideas, the one I think would be most acceptable and have the highest impact in the US is to have a committee that reviews the cost-benefit and scientific data supporting various treatments (such as the NICE committee in the UK), and have government subsidies for those treatments. We already have a functional system like that, in that Medicare coverage drives the insurance reimbursements for almost all medical services. Furthermore, the US government makes recommendations about acceptable screening practices through the US Preventative Services Task Force and treatement practices through the CDC. However, even these are not without controversy. The USPTSF just published new guidelines on Mammography which have NOT been accepted by the American Cancer Society, the American College of Obstetrics and Gynecology or the American Medical Association, despite being based on the evidence.
The other idea that might work here is to go to a computer based medical record system. The opposition has a clear argument around personal privacy, however our country has been quick to embrace the mobile media, and would quickly realize the benefits of a uniform, easily accessible medical record, much like they have in Taiwan.
lesson from Taiwan health system
From watching Frontline: Sick Around America, we all learned that Taiwan has single-payer health system with universal coverage at relative affordable cost. Although Taiwan is a small nation with spending half of GDP as US, how do they manage demand vs. supplies sides and balance revenues vs. costs? In Taiwan, people have smartcard, uniform system of electronic health records, which gives doctors their basic medical background. This is not only saving health care administrative cost but also good way to track their health status as well as monitoring utilization of health care system. One thing different from Canadian health system is that Taiwan system has shorter waiting list and they are free to choose any doctors without using gatekeepers. I really like the fact that Taiwan health insurance covers both western and oriental medicines as well as dental and prescription drugs even nursing home (wide comprehensive coverage) at low cost for all. They also focus more on preventive medicines by offering wide coverage from Chinese natural herbs and acupuncture as well as western medicines. I am not sure whether single payer system or socialized health system works or not in US but I think US can learn that we can have universal coverage and good quality health care system while still managing to control health care costs.
Taiwan
Although Professor Hsiao says they adopted a system similar to Canada's single payer system in Taiwan, it is easy to recognize aspects similar to other countries. Taiwan allows its citizens to choose their providers similar to Germany and the UK. It is comprehensive like the UK and Canada, it covers herbal practitioners and acupuncturists like many other Asian nations, and it also covers dental, vision, long term care, and in home nursing. There are co-pays to pretend the longevity of the system, unlike the UK. This system is really good and their are positive results to prove it.
On behalf of the US, I would most likely adopt the universal mandate from Netherlands. The risk pool idea of having everyone insured or if not insured still contributing to the pool really makes sense.
On behalf of the US, I would most likely adopt the universal mandate from Netherlands. The risk pool idea of having everyone insured or if not insured still contributing to the pool really makes sense.
Monday, November 23, 2009
Team Taiwan
Since learning about the Taiwanese system in class, I am all about incorporating many aspects of their health care organization into my "ideal" health care system. According to the interview with the Harvard economist that helped to develop the Taiwanese reform, it was interesting that they chose to use the Canadian system. I feel like the one aspect that should be mandatory in the perfect system would be a smart card. Its the single best way to integrate medical records, track uses of each patient, ensure access to services, and keep medicine streamlined electronically.
I can even imagine the world of good if the U.S. decided to implement a smart card. Patients wouldn't be over-prescribed medication or doctors would have a more honest view of what patients use. Deaths like Michael Jackson's may be avoided with a smart card; his doctor prescribed him a sleep aide that was already administered at Jackson's request which directly contributed to his cardiac arrest and death. Even though many are uninsured in America, there are plenty of abusers among those that receive insurance through employers or Medicare.
I thought it was a brilliant idea of Taiwan to initially recognize the need for health care reform and most importantly, look at other successful nations. Its amazing to me that they actually hired an outside consultant in the matter as well. I think most countries would not dare to do that, but it makes sense as the Harvard professor would have no biases or interests in a health care system that would largely unaffect him. Its amazing to think they delegate a very small number of leaders to head their reform and the U.S. has such a large and complicated reform committees. It is also eye-opening to see how fast reform can be passed in Taiwan and how political our country has become where it takes ages to change anything.
I can even imagine the world of good if the U.S. decided to implement a smart card. Patients wouldn't be over-prescribed medication or doctors would have a more honest view of what patients use. Deaths like Michael Jackson's may be avoided with a smart card; his doctor prescribed him a sleep aide that was already administered at Jackson's request which directly contributed to his cardiac arrest and death. Even though many are uninsured in America, there are plenty of abusers among those that receive insurance through employers or Medicare.
I thought it was a brilliant idea of Taiwan to initially recognize the need for health care reform and most importantly, look at other successful nations. Its amazing to me that they actually hired an outside consultant in the matter as well. I think most countries would not dare to do that, but it makes sense as the Harvard professor would have no biases or interests in a health care system that would largely unaffect him. Its amazing to think they delegate a very small number of leaders to head their reform and the U.S. has such a large and complicated reform committees. It is also eye-opening to see how fast reform can be passed in Taiwan and how political our country has become where it takes ages to change anything.
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