Since 2004, the Taiwan Joint Commission on Hospital Accreditation has promoted “Patient Safety Week.” From 2020 onward, the promotion was extended to cover the whole week of Sept. 17.
This week marks the 20th year of the event. However, despite Taiwan’s globally acclaimed healthcare system and National Health Insurance, why have its hospitals not been able to establish a strong international reputation for patient safety? What has caused this?
Last year, Newsweek included Taiwan in its global ranking of the best hospitals for the first time.
That year, National Taiwan University Hospital (NTUH) placed 249th in Newsweek’s top 250 hospitals.
This year, NTUH has dropped out of the list, while Taipei Veterans General Hospital (TVGH) placed 218th, making it the only Taiwanese hospital in the top 250.
Compared with other countries in the Asia-Pacific region, Taiwan lags far behind.
Seventeen South Korean hospitals are included in this year’s list, with the top-ranked hospital in 22nd place.
Malaysia, which had no ranking hospitals last year, now has two, with the highest ranked 223rd.
Thailand, like Taiwan, has only one hospital ranked, but at 130th, it far surpasses TVGH.
India has three hospitals included in this year’s list, and the highest-ranked hospital is in 113th place.
Are Taiwanese satisfied with this performance? Are they not curious about how and why NTUH fell out of the top 250?
Taiwan should have at least two hospitals in the list, right?
There are likely three reasons for this.
First, there is a lack of medical data transparency in Taiwan. Key data on medical incidents, hospital mortality rates, infection rates and readmission rates — critical indicators of patient safety — are hard to access.
This prevents a comprehensive assessment of the healthcare system’s performance in terms of patient safety and makes it difficult to compare with other countries.
Second, data on hospitals and specific departments are rarely made available. Given there is no strong government intervention, few medical institutions conduct self-assessments on internal patient safety issues.
Even if they do, the results are rarely disclosed, leaving patients and the public in the dark about how specific departments fare in areas such as surgical complications or infection control.
In other countries, including South Korea and Japan, hospital or department-specific patient safety data is often made transparent.
NTUH might be perceived as being excellent because of its name and its access to Taiwan’s vast medical resources, but do their departments lead in their respective fields? Do they maintain low preventable death rates?
Nobody knows.
Third, there is a lack of effective mechanisms for handling medical errors and providing compensation.
Taiwan’s medical compensation system is immature, often requiring lawsuits to resolve issues, meaning that many medical errors are underreported or unreported.
No-fault compensation systems, which reduce doctors’ incentive to hide mistakes and improve patient safety, have never been seriously considered.
If Taiwan wishes to enhance its international reputation in patient safety, the Ministry of Health and Welfare needs to focus on three areas.
First, shift from protecting doctors and hospitals to a patient-centered approach by making medical data publicly available, particularly data related to patient safety and medical incidents at all hospital levels.
This would increase domestic and international trust in Taiwan’s healthcare institutions and foster healthy competition between hospitals, which would help to improve outcomes.
Second, beyond boosting transparency, healthcare institutions must strengthen patient safety culture by encouraging staff to report errors, conducting regular safety training and establishing effective risk management systems.
Third, explore the feasibility of implementing a no-fault compensation system in conjunction with restorative justice to resolve medical disputes, encouraging hospitals to be more willing to disclose errors, thereby improving patient safety.
While the National Health Insurance system is internationally recognized for its accessibility and basic coverage, its patient safety data is not transparent, and therefore the healthcare system cannot establish a global reputation.
The accessibility and affordability of Taiwan’s healthcare system could appear deceptive if, behind the scenes, medical quality is not properly monitored, leading to unnecessary tests or overtreatment that wastes medical resources.
The lack of transparency in patient safety data means that the public cannot fully grasp the rate of medical errors or treatment complications, which could indicate inefficiencies or safety risks in a supposedly convenient system.
Although medical treatment accessibility might be high in Taiwan, if people experience medical errors or substandard care, these resources could end up being wasted on treating complications or repeated visits, imposing a greater burden on patients and the system as a whole.
Thus, the Ministry of Health and Welfare should end the era of inviolable medical authority in Taiwan.
If it truly wants to create a patient-centered healthcare system, it must combine no-fault compensation with transparent, hospital and department-specific patient safety data and evaluations.
Chu Jou-juo is a professor in the Department of Labor Relations at National Chung-cheng University.
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