The influence of medical cost controls implemented by Taiwan's national health insurance program on doctor–patient relationships

Abstract

To prevent medical costs from rising, the National Health Insurance administration implemented the global budget system for financial reform, effective 1 July 2004. Since the implementation of this system, patients have been required to pay for some medicines to limit costs to the system. More recently, as they have faced constant increases in health insurance fees and also faced an increase in the number of medical expenses they must pay during an economic recession and a rise in unemployment, would the economic burden on the people of Taiwan not be increased? Even though National Health Insurance is a form of social insurance, does it guarantee social equality? The value of the healthcare industry is irreplaceable, so the most critical concern is whether worsening doctor-patient relationships will worsen healthcare quality. In short, while the global budget system saves on National Health Insurance costs, whether its implementation has affected healthcare quality is also worth exploring. This commentary also hopes to serve as a reference for the implementation of national health insurance in the United States.

A quarter of century after: The changing ecology of psychiatric emergency services

“…Third, the National Health Insurance of Taiwan started in 1995 may also change the ecology of emergency psychiatry dramatically. It makes the emergency services more affordable and available to all patients particularly for patients with certificates of catastrophic illness (e.g., schizophrenia), impacts the clinical practice pervasively (Chiu, 2015; J. C. Hsu & Lu, 2015) owing to the shorter length of stay of patient in psychiatric facilities (Lee et al, 2016; Tulloch et al, 2011), also creates crowding EDs and increased the loading of the entire medical system (C. C. Hsu & Chan, 2018). How the insurance system influences the ecology of psychiatry emergency deserves further qualitative study.…”

“…These numbers suggest that not only the "neurosis" but also the "psychosis" categories were composed of more females than males, implying that the proportion of females is increasing across various diagnoses, and this increase cannot be totally explained by the increased proportion of "neurosis." Whether patients particularly for patients with certificates of catastrophic illness (e.g., schizophrenia), impacts the clinical practice pervasively (Chiu, 2015;J. C. Hsu & Lu, 2015) owing to the shorter length of stay of patient in psychiatric facilities (Lee et al, 2016;Tulloch et al, 2011), also creates crowding EDs and increased the loading of…”