Dr Huang Da-Fu/ Superintendent of the KFSYSCC

It’s inevitable that in the future, AI will play an important role in healthcare system.  However, we should not forget that AI is just a tool which can improve the quality and efficiency of healthcare.  In fact, health policies and reimbursement system have the most profound impact on the public’s welfare. 

Michael Porter mentioned value-based healthcare in his book “Refining Healthcare”.  Porter pointed out that “fee-for-service” reimbursement system only contributes to higher health expenses without delivering healthcare quality.

Therefore, he suggests that the healthcare industry should embark on a reform and shift the focus from quantity to quality; and the reimbursement system should reward healthcare quality and treatment results.

Western experts and scholars have been working on various indexes for monitoring healthcare quality and promoting “payment-by-result” reimbursement methods.  It shows that when healthcare providers follow the evidence-based healthcare guidelines and reduce the discrepancy in treatments provided by doctors, it can enhance the healthcare results and lower the cost.

In Taiwan, there are constant reports about sweat hospitals, overworked doctors and nurses, medical disputes, etc.  However, the discussions about healthcare reform are rare. 

The NHI spending is under 7% of the GDP.  In Taiwan, the private market is about the same size as the NHI market.   Most of the spending in the private market is on healthy food, expensive tests and advanced therapies.  But, whether the spending is worthwhile still requires discussion. 

Though the NHIA has not yet found methods to effectively control waste and abuse, punishments are in place as a remedial measure.  However, the private market is beyond the NHIA’s control; hence, the waste and abuse of resources are quite common.  For example, evidence shows that it is more harm than good to use low-dose CT scan for lung cancer screening in non-high risk patients.  However, this practice is quite common in big hospitals in Taiwan.

Healthcare is not only a non-profit business, but also a charitable business.  The “fee-by-service” reimbursement system has caused the waste and abuse of resources.  Low payment prices have driven hospitals to provide unnecessary services and to persuade patients opt for private treatments.  Patients become victims due to information asymmetry.

The public must have the awareness of their health condition and take control of it.  Apart from leading a healthy lifestyle, the public should be proactively involved in the healthcare reform and support a quality-oriented system.  When hospitals keep their expense accounts and treatment results in the public domain for the public’s access, patients will then have sufficient information to choose the most appropriate service.  Finally, profit-driven hospitals will be forced out of the market.

【2018-02-06/ United Daily】