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Health System and Health Professionals in Taiwan

Health System and Health Professionals in Taiwan. Hsiu-Hung Wang, PhD, RN Deputy Minister of Health The Executive Yuan, Taiwan Sep. 15, 2005. Department of Health,Taiwan. Vision: . Healthy Taiwan Promise people safe and healthy lives. Department of Health,Taiwan. Mission.

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Health System and Health Professionals in Taiwan

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  1. Health System and Health Professionals in Taiwan Hsiu-Hung Wang, PhD, RN Deputy Minister of Health The Executive Yuan, Taiwan Sep. 15, 2005

  2. Department of Health,Taiwan Vision: Healthy Taiwan Promise people safe and healthy lives

  3. Department of Health,Taiwan Mission 1. To improve the health of people 2. To become the educator in health matters for the people 3. To be the promoter of healthcare industries 4. To be the participant in international health affairs

  4. Profile of Taiwan (2004) • Population: 22.60 million • Land area: 36,188 km2 (14,000 mile²) • Population density: 625 per km2 • Neonatal mortality rate: 2.88 ‰ • Infant mortality rate: 5.35 ‰ • Maternal mortality rate: 1.97 ‰ • Population aged over 65: 9.5% • Life expectancy: 79.41 (female) 73.60 (male) • GNP per capita : US $13,529 • NHE as % of GDP: 6.26%

  5. Department of Health,Taiwan Health Professionals in Taiwan

  6. Number of Medical Personnel(July, 2005)

  7. Number of Medical Personnel(July, 2005)

  8. Comparison on the Manpower of Medical Personnel to Service Population Notes: 1. Data resources: IMD World Competitiveness Yearbook 2004 2. The number of each physician and nurse serve at the above countries are based on the assessment of data in 2003. 3.The number of patients of Taiwan’s physician serves are accounted as the number of both physicians and Chinese medicine doctors divides the total number of population

  9. Medical Personnel Granted Licenses • Taiwan has 20 kinds of medical personnel: • Physicians, dentists, Chinese medicine doctors, pharmacists, assistant pharmacists, registered professional nurses, registered nurses, registered professional midwives, midwives, dietitians, medical technologists, medical radiation technologists, physical therapists, occupational therapists, physical therapy technicians, occupational therapy technicians, medical technicians, clinical psychologists, counseling psychologists, respiratory therapists.

  10. Medical Personnel Granted Licenses in Process • dental technologists • audiologists • optometrists

  11. Legislation Year Regarding Medical Personnel

  12. Act of Medical Personnel Management • General: Qualification rules • Practice: regulation of practice registration, continuing education, participation in local association and rules to reissue certificates • Obligation • Sanction: requirements, methods, the establishment of sanction committee, rules of penalty and annulment of certificates • Professional Society

  13. Specialization of Physicians • Physicians’ Specialities: Family Medicine, Internal Medicine, Surgery, Pediatrics, Gynecology, Orthopedics, Neurology Surgery, Urology, Otolaryngology, Ophthalmology, Dermatology, Neurology, Psychiatry, Rehabilitation, Anesthesiology, Radiology, Pathology, Nuclear Medicine. • Physicians who join specialist qualification examinations are confined to twofields.

  14. License’s Renewal • Medical personnel is subject to management guidelines to renew licenses. • Currently, physicians, clinical psychologists, medical technologists, medical radiation technologists, dietitian’s, respiratory therapists, registered professional midwives and midwives comply with the law to renew licenses. • For the others, the relevant bill is accessed by the Legislative Yuan.

  15. Valid Term of Licenses for Medical Personnel

  16. Control of Medical Manpower • Medical students are under number control in which the maximum of 1300 applicants are admitted each year. • Regarding other medical manpower, relevant departments and institutes are established with the endorsement from Taiwan’s ministry of education. With respect to medical departments, the proposal should be submitted with the examination and management by the ministry of education.

  17. Action Plans for Medical Manpower • Setting up guidelines for specialization and qualification of physicians according to physician’s act in 1998 • Training physicians on government scholarships at remote areas • Promoting physicians to receive complete professional clinical training • Promoting training program on international health • Promoting on-job training program for nurses

  18. Post-graduate year one(PGY1) program for physicians • This pilot program launched in August 2003 after SARS outbreak for the first year resident • Purposes: • Providing hospital and community based training • Accumulating experiences for taking care for patients from cradle to grave • Enhancing the first year residents’ acquisition of detailed factual knowledge, the development of clinical skills and professional competence in general medicine

  19. Post-graduate year one(PGY1) program for physicians • Curriculum: • General medicine: 36 hrs • Community medicine: 1 month • General surgery: 1 month • Internal medicine: 1 month • Residents should finish above courses within one year

  20. Post-graduate year one(PGY1) program for physicians Outcome for the pilot program: • $NT 70,000 ($US 2,190) per month per resident paid by government budget • 60 teaching hospitals participated in the program by 2004 • 95 physicians have finished the preceptor training for PGY1 by 2004 • 1,419 residents finished the PGY1 training by Aug 2005

  21. Department of Health,Taiwan Nurse Practitioner (NP) System

  22. Purposes of Establishing NP System in Taiwan • To upgrade the quality of medical services and prevent and reduce medical errors. • To improve collaboration between physician-nurse team work. • To readjust patient care tasks shared between physician and nurse. • To improve physician-patient and nurse-patient relation. • To establish a national standard for Training Programs and Licensure System for NP to • ensure the high level of NP competencies.

  23. Role of the Nurse Practitioner  Major role: To provide continuous and integrated medical and nursing care collaboratively with physicians.

  24. The Development of NP System Major Achievements of the Establishment since 2001: 1. Has completed a report on “recommendations on the development of NP and related regulations” 2. Has completed a pilot project on “ the training program of NP and related regulations” 3. Has completed a project on the training of seed clinical instructors for NP

  25. A Policy Proposal on Training Program Designing and Practice Model for Nurse Practitioners in Taiwan (published by NHRI Forum/Center on Health Policy R&D in July 2004)

  26. Regulations Governing Specialties and Examination of Nurse Practitioner Promulgated on Oct. 27, 2004 by the Department of Health

  27. Advisory Committee of the NP • Chairman : Deputy Minister of DOH • Nursing experts • Medical experts • Director, Bureau of Nursing and Healthcare, DOH • Director, Bureau of Medical Affairs, DOH

  28. Department of Health, Taiwan National Health Insurance (NHI)

  29. Development of Social Insurance Programs in Taiwan 1950 Laborer’s Insurance 1958 Government Employee’s Insurance 1985 Farmer’s Insurance 1990 Low-income Household Insurance 1995 National Health Insurance (Consolidating the health care component of existing insurance programs into one)

  30. Major Achievements of NHI • Universal enrollment • Comprehensive coverage • Easy access • Affordable cost • Acceptable quality • High satisfaction

  31. Universal Enrollment Population Covered：22 million (99%), 2004 • Staying abroad • In transition of jobs • Reluctant to join

  32. Comprehensive Coverage • Inpatient care • Ambulatory care • Laboratory tests • Prescription drugs and certain OTC drugs • Dental services • Traditional Chinese medicine • Day care for the mentally ill • Home care • Some preventive services

  33. Easy Access • Medical care institution contract rate : 93% • No. of physicians per 10,000: 16 • No. of beds per 1,000: 60

  34. Total Health Expenditures as % of GDP, 1983-2003 NHI Total Health Expenditures Out-of-pocket Health Insurance Government Sector

  35. Worldwide Health Rankings Taiwan The Economist Intelligence Unit (2000) Healthcare International, 2nd quarter 2000: 66-67, 72-75

  36. High Satisfaction (1998～2004) Satisfied (DOH) Satisfied (BNHI) Dissatisfied (DOH) Dissatisfied (BNHI) 05/95 09/95 06/96 01/98 04/98 11/98 05/99 03/00 10/00 06/01 12/01 05/02 11/02 07/03 12/03 04/04 09/04 12/04

  37. Department of Health,Taiwan Cancer Control

  38. Changes of Main Causes of Death 1952 2004 1 2 3 4 5 Malignant tumor Gastroenteritis Pneumonia Cardiac disease Tuberculosis Cerebrovascular diseases Cardiac disease Injury Diabetes Vascular disease of central nervous system crude death rate 950.80 crude death rate 590.28 • 0.1 million (population)

  39. Five Leading Causes of Death Data resource: Ten Main Causes of Death Rate in 2004, Ministry of Health, the Executive Yuan, TAIWAN

  40. Five Leading Sites of Cancer in Taiwan Per 100,000

  41. Rationale for Screening Policy WHO’s suggestion on screening: • Cervical ca. and breast ca. screening are effective • Colorectal ca. screening is partially effective Incidence of oral and liver cancer is high in Taiwan and domestic data proved screening is effective

  42. Cancer Screening Programs

  43. Infrastructure of Screening • Delivery system of screening services • Accreditation program for cytology and mammography • Computerized information system for each cancer screening program

  44. Strategies • Establish evidence-based screening models • Include screening in the National Health Insurance • Improve public awareness of early signs of cancers • Reduce screening obstacles and improve coverage • Establish an effective referral system for screening positive cases • Establish quality monitoring system for screening • Establish screening databanks for monitoring and evaluation

  45. Department of Health,Taiwan Disease Prevention and Control

  46. Communicable Disease Control Surveillance Prevention Quarantine Strengthen Control System Avoid Disease Threats International Cooperation Information Management Research Infection Control

  47. Immunization Program • Small pox vaccination started in 1906 • DPT vaccination in 1954 • Polio vaccination in 1966 • HB vaccination in 1984

  48. Eradication of Communicable Diseases • Plague 1948 • Smallpox 1955 • Rabies 1959 • Malaria 1965 • Poliomyelitis 2000

  49. National Health Command Center (NHCC)

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