Brian Hioeby Brian Hioe
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Photo Credit: Solomon203/WikiCommons/CC BY-SA 3.0
AN OUTCRY ABOUT the crisis in Taiwan’s medical sector has broken out yet again. At the same time, one notes that many solutions have been proposed in past years, and they have similarly failed to be effective. At a time of stark budget cuts pushed for by the pan-Blue camp, such solutions are less likely than ever to be effective at present.
Controversy has been renewed after the Lunar New Year, during which emergency rooms were congested because of a lack of hospital beds. In February, the Taiwan Society of Emergency Medicine called the situation unprecedented, and stated that the medical industry could see further departures of staff at a time when there have already been waves of departures.
Though health authorities have stated that efforts will be made to strengthen coordination between regional hospitals to ensure adequate bed capacity, the Taipei Doctors Union has stated that new mechanisms need to be developed to coordinate.
For one, the problem is contributed to by the fact that many Taiwanese go to emergency rooms even when they do not urgently need emergency treatment because it is quicker to do so, go to larger hospitals rather than smaller facilities, or prefer to go to hospitals they are more familiar with. New mechanisms are needed to financially incentivize patients from not doing this. But when hospitals report to the regional Emergency Operation Center that they lack beds, there is no further action taken to remedy the issue. This points to the fact that referral and transfer systems in Taiwan do not allow forced transfers and have not been sufficient to fix the issue, and that there is a lack of real-time monitoring systems for hospital capacity.
More broadly, medical workers who are employed as nurses and doctors are not paid enough, work long and late hours, and face brutal work conditions. As a result, 1,700 nurses quit in the first six months of 2023 alone.
In 2023, the nurse-to-patient ratio in Taiwan was between 1:13 and 1:15. According to surveys, nurses take care of 11.55 people during day shifts, 15.55 people during shorter night shifts, and 17.88 people during longer night shifts. Some nurses at regional hospitals have reported taking care of as many as 26 patients during night shifts. Ratios of attending physicians are also problematic, in that physicians handle thirty to forty patients when they previously handled twenty to thirty patients.
Photo credit: Tianmu peter/WikiCommons/CC BY 3.0
Nurse union representatives have pointed out that Taiwan has among the highest nurse-to-patient ratios in the world. Taiwan’s nurse-to-patient ratio is higher than the US, Australia, the UK, and Japan. A high nurse-to-patient ratio increases the odds of mortality for patients. According to research, if the number of patients being cared for increases from 4 to 5, this increases the mortality rate in 30 days by 7%. If the number of patients being cared for increases to 8, this increases the mortality rate by 31%.
While the Ministry of Health and Welfare introduced nurse-to-patient ratios for three shifts of medical work in 2024, with the aim of keeping hospitals running during nighttime hours, and largely used financial stipends for nurses working overtime shifts to do this. Currently, the government proposes expanding subsidies as night-shift bonuses to cover nurses working in all special hospital wards rather than only providing them to those working acute care beds. Likewise, the government has singled out that not enough hospitals are in compliance with these regulations.
In light of the current shortage, the government is considering adjusting these ratios. Still, the problem of the matter is that medical workers often do not want to work in emergency rooms, but prefer working in other medical facilities in light of these current conditions. And, given the tough labor conditions facing nurses, there is a shortage of nurses.
Even so, if the proposed solutions by the government are primarily based on using subsidies to incentivize certain behavior from medical workers or hospitals, this is likely to face challenges at a time when the pan-Blue camp has proposed cutting 34% of available government spending in the name of fiscal balance–despite record-high tax revenues.
More generally, it is noteworthy and telling that the government intends to fix the fundamental issue at hand by using subsidies and stipends to incentivize behavior, rather than improving compliance with labor laws. By contrast, nurse unions have called for an increase in labor inspections so as to ensure that labor regulations are being followed. Though implementing a three-shift system was a demand that originally came from unions, that the government aims not to punish hospitals that fail to maintain nurse-to-patient ratios, but to incentivize them to make changes proves a means of treating healthcare as a business rather than a basic social service.