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An Overview of the Healthcare System in Taiwan
Public Health Organization Structure
Taiwan's health administration organization is divided into the
central level and local level (city and county governments). At the central level,
the Department of Health (DOH) under the Executive Yuan is the highest health administration
agency, responsible for the administration of health matters nationwide and the
guidance, supervision and coordination of local health bureaus. At the local level,
each of the 23 county and city governments and special municipalities of Taipei
and Kaohsiung operates a health bureau, responsible for advancing health and medical
operations within their respective jurisdiction. DOH Bureau of Medical Affairs is
highly related to the operation and management of medical organizations. The bureau
is responsible for the following areas including laws regarding medical affairs,
quality counseling of medial organizations, emergency rescue services, psychotherapy
and mental hygiene, and the management of human resources in health and medical
organizations. The central health administration agency in Taiwan is the DOH, and
local governments administer in special municipalities and county and city governments.
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Figure 3.1 Current Health Administration Systems in Taiwan
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Hospital Distribution
1.The Operation Model of Taiwan's Medical Systems
The operation model of medical systems in Taiwan mostly applies to closed-staff
systems. Hospitals recruit licensed doctors that only practice within specific hospitals.
The management of the hospital is diversified, with emergency treatment, and outpatient/inpatient
services.
2.Introduction to Current Medical Organizations and Medical Service Capacity
in Taiwan
Hospitals in Taiwan can be categorized according to ownership (public hospital,
private hospital, and corporate hospital), type of medical treatment provided (general
hospital, chronic disease hospital, and psychiatric hospital), education capability
(teaching hospital and non-teaching hospital), and level of accreditation (medical
center, regional hospital, and district hospital).
(1)The Distribution of Hospitals in Taiwan
As of the end of 2004, there was a total of 590 hospitals, which included 556 hospitals
of Western medicine (88 public hospitals and 168 private hospitals), and 34 hospitals
of Chinese medicine (2 public hospitals and 32 private hospitals). The greater Taipei
region had more medical resources, with a total of 116 hospitals.
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Figure 3.2 Hospital Subordinates |
(2) Analysis of Practicing Medical Personnel per 10,000 Heads
As of the end of 2004, the total number of practicing medical personnel in medical
organizations was 192,611. This includes 21.1 practicing doctors, 44.9 nursing personnel
(registered professional nurses, nurses, midwives), and 11.5 pharmaceutical personnel
(pharmacists, assistant pharmacists) per 10,000 heads (Please refer
to Table 3.3).
In recent decades, there have been changes in the number of practicing medical personnel
per 10,000 heads. An increase of 19.1 in nursing personnel outnumbers the increase
in other medical personnel. An increase of 4.9 in doctors comes second, followed
by 2.6 in pharmaceutical personnel, and 1.8 in medical radiological technologists
and medical examiners per 10,000 heads.
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2004 Year-End Units: per 10,000 heads
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Medical Personnel
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Total
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Doctors
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Pharmaceutical Personnel
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Medical Radiological Technologists and Medical Examiners
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Nursing Personnel
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Physical Therapists and Occupational Therapists
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Grand Total
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84.89
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21.07
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11.49
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4.77
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44.92
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2.17
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Table 3.3 Number of Practicing Medical Personnel in Medical Organizations in Taiwan |
(3) Analysis of the Number of Full-Time Doctors per Department in the Hospital
Doctors practicing in Taiwan hospitals are certified by a general medical license,
with a high percentage of doctors receiving professional medical licenses. As of
the end of 2004, the number of full-time professional doctors was 14,964. On average,
the percentage of full-time professional doctors in every hospital reached 69.2%,
with equivalent percentages in both public and private hospitals. Among the number
of full-time professional doctors in public western hospitals, Veterans Hospital
had the highest ratio of 90.5%, followed by 79.6% in DOH-affiliated hospitals, and
Kaoshiung and Taipei municipal hospitals, and 72.2% in armed forces hospitals (civilian
clinics).
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Year
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Public Hospitals
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Public Hospitals
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Veterans Hospital
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Armed Forces Hospital-Civilian Clinics
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Hospitals Subordinate to DOH and City Hospitals in Taipei and Kaohsung
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Non-Profit Proprietary Hospital
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Hospitals Affiliated with Medical Schools
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Hospitals Affiliated with Non-Profit Proprietary Religious Organizations
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Hospitals Affiliated with Non-Profit Proprietary Religious Organizations
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Private Hospitals
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2004
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90.5
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72.2
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79.6
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75.8
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71.7
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64.7
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72.1
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59.7
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Table 3.4 The Ratio of Professional Doctors in Taiwan’s Hospital |
(4) Analysis of Hospital Bed Capacity
As of the end of 2004, the number of hospital beds was 127,667, which is 56.3 beds
per 10,000 heads. Of various kinds of hospital beds, general beds account for 74.2%,
with a total of 94,659; special beds account for 25.9%, with a total of 33,008.
Acute general beds account for 76.4% as the highest among general beds.
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Figure 3.3 Total Number of Hospital Beds in Major Hospital Countries |
(5) Hospital Medical Service Capacity
A. Analysis of General Bed Service Capacity
In 2004, the average bed occupancy rate for general beds was 71.1%, with an average
of 9.6 days of hospitalization. The bed occupancy rate for special beds is 57.9%,
with an average of 10.21 days of hospitalization.
B. Analysis of Medical Service Capacity
a. Person/time of Outpatient Visits
The accumulated number of outpatient visits in 2004 reached 101,687,332 Public hospitals
occupied 27.5%, and private hospitals took up 72.5%.
b. Person/Time of Emergency Treatment
The accumulated number of emergency treatments in 2004 was 6,870,499. Public hospitals
occupied 27.4%, and private hospitals took up 72.6%. This increased 12.1% from last
year.
c. Person/Time of Surgery
The accumulated number of surgeries in 2004 was 1,707,502. Outpatient surgery occupied
44.4%, and inpatient surgery took up 55.6%. Public hospitals accounted for 26.3%,
and private hospitals made up 73.7%.
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Medical Education in Taiwan
Medical education in Taiwan sprouted as early as the Japanese occupancy. At the
beginning of the Retrocession, the only medical institution was Taihoku (Taipei)
Imperial University Medical College (the predecessor of National Taiwan University
Hospital). To date, there
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◆ PACS in one Medical University Hospital |
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are 11 medical colleges and many other medical related schools. The medical schools
of different educational systems provided various kinds of professional medical
training.
1. Medical Education
Current medical education in Taiwan includes: (1) education for Medical college
students (Bachelor of Medicine); (2) education for professional doctors(resident
doctor training); (3) education for fellowships; (4) lifelong learning education.
The medical course for medical college students consists of 7 years of study, which
includes internship education. Upon receiving the Bachelor of Medicine degree, one
shall be certified through national examinations for a medical license prior to
practicing medicine. In order to control the capacity of doctors, DOH put an uppermost
limit of 1300 to Taiwan Medical colleges per year.
2. Nursing Education
At present, nursing education in Taiwan can be divided into vocational schools,
nursing colleges, universities, and graduate schools. In order to enhance the quality
of nursing personnel, vocational nursing schools will be terminated by 2005.
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History of Hospital Accreditation in Taiwan
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The hospital accreditation system originated in the United States. The purpose of
hospital accreditation is to promote medical service quality and establish a foundation
for medical treatment type, while the purpose of teaching hospital accreditation
is to provide medical college students and resident
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◆ Open heart surgery
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doctors an appropriate
place for clinical training. Hospital accreditation in Taiwan began in 1978,
for designating internship hospitals for medical college students, and was jointly
conducted by the Ministry of Education (MOE) and DOH. Only 24 hospitals were certified
as teaching hospitals at that time. From then on, regular teaching hospital accreditation
is conducted every two years.
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The implementation and publicizing of the Medical
Care Act in 1986 authorized the central health administration agency to conduct
hospital accreditation. In 1988, the first comprehensive hospital accreditation
in Taiwan was conducted, and teaching hospital accreditation was conducted jointly
with MOE.Taiwan
is the first in Asia, and the fourth in the world to conduct hospital accreditation.
According to the Medical Care Act, the duration of accreditation validity is 3 years,
and upon PACS in one Medical University Hospital
Open heart surgery expiry, hospitals
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◆ Emergency and Critical Care training program in Chang-Gung Memorial Hospital
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shall
reapply for accreditation. At present, there are 497 certified hospitals with 3-year
accreditation qualification (2005,TJCHA).
Hospital accreditation is organized by the DOH,
and teaching hospital accreditation is conducted jointly by the MOE and DOH. Joint
accreditation of hospital and teaching hospitals was first implemented in 1999,
after the establishment of the Taiwan Joint Commission on Hospital Accreditation
(hereafter referred to as TJCHA). TJCHA is an organization supported through donations
and promotion of the DOH, hospital associations, and medical associations to undertake commissioned hospital accreditation affairs
from the DOH.
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◆ Hyperbaric Oxygen Therapy Center in China Medical University
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The importance of hospital accreditation is highly emphasized in medical organizations,
since the Bureau of National Health Insurance subsidize the hospitals according
to the accreditation type. Higher accreditation types receive more medical subsidies,
while the public believes that higher accreditation implies better medical service.
Hence, hospitals strive to become the hospital of the higher type. During the
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accreditation process, the personnel, facilities, instruments, and service quality
in the hospital can be constantly enhanced, which is a positive and long-term influence
to the patients, society, and hospital personnel.
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