One of my former superiors recently told me that his father had tripped and fallen at home, and started bleeding from the head. When the family called to ask my ex-colleague — a doctor — for help, he told them that it was probably only a flesh wound and asked them to stop the bleeding and then take his father to hospital.
After the wound had been stitched up, he said he would be fine after some rest at home.
While he was happy that his family had someone to call for help, someone else would have had to call 119, and use emergency health insurance resources.
If the National Health Insurance Administration’s (NHIA) Integrated Family Physician Project was perfect and a call center was set up for each healthcare group, the local call center could be called in case of an emergency and the center could determine the situation and give instructions on how to handle it at home.
If assistance by a doctor was required, a doctor from a clinic could be sent over to provide treatment, and if hospital care was required, the doctor could see to it that the patient was taken to a cooperating hospital. This would minimize the waste of resources.
In 2003, the NHIA launched a trial National Health Insurance integrated family physician care system. In the current family physician plan, five or more appointed Western medicine clinics make up one unit in an area, and one or two appointed hospitals make up one community healthcare group. They have a system for referrals and cooperation, creating a community-wide care network.
However, payments are too low, as the administrative fee paid to participating clinics by the NHIA per individual patient is only NT$250 per year, although clinics are required to establish and upload patient journals, arrange referrals, provide healthcare education and have a 24-hour consultation hotline.
This is not very attractive to hospitals, and the results have been lackluster.
If the family physician plan could include consultation centers, people could receive healthcare information and instructions from healthcare personnel via these centers.
The centers could also be used to integrate healthcare resources by sending doctors with different specialties, nurses, nutritionists, physiotherapists and occupational therapists to provide care in the home. They could also provide long-term home care services and transport patients to and from home.
In practice, anyone joining the family physician plan would receive comprehensive, coordinated, continuous and diversified services, and if they obtained medical care without following the path provided by the community healthcare group, they would pay more.
After comparing of the pros and cons, the public would naturally prefer to join the family physician plan.
Health insurance fees really should be raised, but NHIA payment of health insurance-related expenses to clinics should also be adjusted. The Cabinet should set up a cross-ministerial healthcare consultation center.
Lo Pin-shan is the deputy secretary-general of the Taiwan Society of Home Health Care.
Translated by Perry Svensson
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