Emergency rooms across the nation are overcrowded and healthcare workers are stretched too thin. As a result, patients in critical condition are unable to receive proper and timely treatment.
Days ago, a person in Kaohsiung urgently needed to be admitted to an intensive care unit (ICU), but had to travel north to seek medical care due to a lack of available beds in the south. By the time they reached Yunlin County, their condition had worsened to septic shock and, despite rescue efforts, they did not survive. This incident highlights the bottlenecks in the healthcare system, particularly issues surrounding the allocation of emergency and inpatient beds, which severely impact patients’ chances of survival.
The issue of congested emergency rooms is a structural dilemma involving multiple facets of the healthcare system. A shortage of nursing staff prevents hospitals from providing enough beds. People who require hospitalization are thus left stranded in the emergency room, causing a “blocked exit” phenomenon. This problem has been exacerbated by waves of nurse resignations. Some nurses have worked for up to 16 consecutive hours in one day. Such long hours combined with a high-pressure work environment can cause burnout, leading many to leave the healthcare system and creating a vicious cycle. When the ratio of nurses to patients becomes severely unbalanced, healthcare workers are unable to provide adequate and quality care. The nurse-to-patient ratio has reached one to 10 and, in some cases, even one to 20.
The root cause of overcrowding in emergency rooms lies in the insufficient supply of inpatient hospital beds. However, under the National Health Insurance (NHI) system and medical management model, hospitals are more likely to prioritize scheduled inpatients over those admitted via the emergency room. As such, emergency cases face longer waiting times, sometimes even missing the optimal window for treatment. The government has recommended that patients experiencing mild symptoms visit smaller local clinics or hospitals. However, the reality is that many local hospitals are equally overcrowded — some have even closed down some wards, making it difficult for patients to be transferred or admitted.
Properly addressing the issue of emergency room congestion would require simultaneous and multifaceted reforms. The government should strengthen training and retention mechanisms for nursing staff, increase their salaries and benefits, and improve their work environment to reduce turnover rates. Additionally, the allocation system for inpatient wards should be re-evaluated to ensure that critically ill patients receive priority for beds, rather than relying on the scheduled inpatient admission system.
The NHI reimbursement mechanism should appropriately increase reimbursement rates for emergency rooms and ICUs to ensure that hospitals are willing to invest more resources into the care of critically ill patients. Finally, a regional healthcare cooperation system should be established to allow hospitals across different areas to better allocate available beds and medical staff, thereby preventing patients from being transferred between hospitals and ultimately losing their lives as a result of treatment delays.
Taiwan’s healthcare system is regarded as one of the best in Asia. However, if the fundamental issues of medical resource allocation are not addressed, it might face even greater challenges ahead. In the event of a larger-scale infectious disease outbreak or other sudden incident, our current system might struggle to manage, which could trigger a national public health crisis.
Roger Chen is a master’s student at National Taiwan University College of Medicine’s Department of Medical Education and Bioethics.
Translated by Kyra Gustavsen
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