05 International Disc Models Taiwan

7/28/2019 05 International Disc Models Taiwan

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Health System and Health

Professionals in Taiwan

Hsiu-Hung Wang, PhD, RN

Deputy Minister of Health

The Executive Yuan, Taiwan

Sep. 15, 2005


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Bureau of Medical AffairsBureau of Medical Affairs Bureau of Pharmaceutical AffairsBureau of Pharmaceutical Affairs

Bureau of PlanningBureau of Planning

Bureau of International CooperationBureau of International Cooperation

Bureau of Food SafetyBureau of Food Safety

Bureau of Nursing and HealthcareBureau of Nursing and Healthcare

Committee of Hospital ManagementCommittee of Hospital Management

SecretariatSecretariat

Bureau of National Health Insurance (NHI)Bureau of National Health Insurance (NHI)

Center for Disease ControlCenter for Disease Control

Bureau of Health PromotionBureau of Health Promotion

National Laboratory of Food and Drug AnalysisNational Laboratory of Food and Drug Analysis

Committee of Chinese Medicine and PharmacyCommittee of Chinese Medicine and Pharmacy

NHI Supervisory CommitteeNHI Supervisory Committee

NHI Dispute Meditation CommitteeNHI Dispute Meditation Committee

NHI Medical Expenditure Negotiation CommitteeNHI Medical Expenditure Negotiation Committee

MinisterMinister

CounselorsCounselors

ChiefChief

SecretarySecretary

DeputyDeputyMinistersMinisters

Organization of the Department of HealthOrganization of the Department of Health


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Healthy Taiwan

Promise people safe and healthylives

Vision:

Department of Health,Taiwan


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1. To improve the health of people

2. To become the educator in health matters

for the people

3. To be the promoter of healthcare industries

4. To be the participant in international healthaffairs

Mission



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Profile of Taiwan (2004)

Population: 22.60 million

Land area: 36,188 km2

(14,000 mile)

Population density: 625 per km2

Neonatal mortality rate: 2.88

Infant mortality rate: 5.35

Maternal mortality rate: 1.97

Population aged over 65: 9.5%

Life expectancy: 79.41 (female)

73.60 (male)

GNP per capita : US $13,529

NHE as % of GDP: 6.26%


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Health Professionals in Taiwan



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Number of Medical Personnel(J uly, 2005)

Medical Personnel Number of

Professionals

Number of

Professionals per

10,000

Physicians 673 14.87

Chinese medicine

Doctors

4817 2.08

Dentists 2259 4.43

Registered

Professional Nurses

294 34.04

Registered Nurses 723 13.84

Pharmacists 1121 8.92

Assistant Pharmacists 3031 3.30


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Number of Medical Personnel(J uly, 2005)

Medical Personnel Number of

Professionals

Number of

Professionals per

10,000

Medical Radiation

Technologists

6192 1.61

Nutritionists 12421 0.81

Physical Therapists 9579 1.04

Occupational Therapists 18510 0.54

Clinical Psychologists 52740 0.19

Counseling Psychologists 79478 0.13

Respiratory Therapists 23978 0.42


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Comparison on the Manpower of MedicalPersonnel to Service Population

Germany

France

USA

Australia

New

Zealand

Japan

UK

Hong

Kong

Korea

Taiwan

Singapore

Number of

each

physicianserves

291 297 361 414 441 476 492 617 585 634 688

Number of

each nurse

serves

100 132 96 99 104 185 110 155 253 252 318

Notes: 1. Data resources: IMD World Competitiveness Yearbook 2004

2. The number of each physician and nurse serve at the above countries are based on the assessment of data

in 2003.

3.The number of patients of Taiwans physician serves are accounted as the number of both physicians

and Chinese medicine doctors divides the total number of population


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Medical Personnel Granted Licenses

Taiwan has 20 kinds of medical personnel: Physicians, dentists, Chinese medicine doctors,

pharmacists, assistant pharmacists, registered professional

nurses, registered nurses, registered professional midwives,

midwives, dietitians, medical technologists, medicalradiation technologists, physical therapists, occupational

therapists, physical therapy technicians, occupational

therapy technicians, medical technicians, clinical

psychologists, counseling psychologists, respiratory

therapists.


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Medical Personnel Granted Licenses

in Process

dental technologists

audiologists

optometrists


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Legislation Year Regarding Medical Personnel

Profession Legislation Year

Physicians Act 1943

Pharmacists Act 1943

Midwifes Act 1943

Dietitians Act 1984

Registered Nurses Act 1991

Psychologists Act 2001

Physical Therapists Act 2002

Medical RadiationTechnologists Act

2002

Medical Technologists Act 2002

Respiratory Therapists Act 2002

Occupational Therapists Act 2003


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Act of Medical Personnel Management

General: Qualification rules

Practice: regulation of practice registration,continuing education, participation in local

association and rules to reissue certificates Obligation

Sanction: requirements, methods, theestablishment of sanction committee, rules of

penalty and annulment of certificates Professional Society


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Specialization of Physicians

Physicians Specialities:Family Medicine, Internal Medicine, Surgery,

Pediatrics, Gynecology, Orthopedics, Neurology

Surgery, Urology, Otolaryngology, Ophthalmology,

Dermatology, Neurology, Psychiatry, Rehabilitation,

Anesthesiology, Radiology, Pathology, Nuclear

Medicine.

Physicians who join specialist qualificationexaminations are confined to twofields.


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Licenses Renewal

Medical personnel is subject to managementguidelines to renew licenses.

Currently, physicians, clinical psychologists,

medical technologists, medical radiation

technologists, dietitians, respiratory therapists,

registered professional midwives and midwives

comply with the law to renew licenses.

For the others, the relevant bill is accessed by the

Legislative Yuan.


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Valid Term of Licenses for Medical

PersonnelMedical Personnel Valid Term of Licenses (years)

Physician 6

Medical Technologist 4

Medical Technician 4

Medical Radiation Technologist 4

Medical Radiological

Technician

4

Dietitian 6

Psychologist 6

Respiratory Therapist 6

Midwife 6


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Control of Medical Manpower

Medical students are under number control inwhich the maximum of 1300 applicants are

admitted each year.

Regarding other medical manpower, relevantdepartments and institutes are established with

the endorsement from Taiwans ministry of

education. With respect to medical departments,

the proposal should be submitted with theexamination and management by the ministry of

education.


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Action Plans for Medical Manpower

Setting up guidelines for specialization and

qualification of physicians according to

physicians act in 1998

Training physicians on government scholarshipsat remote areas

Promoting physicians to receive complete

professional clinical training

Promoting training program on international

health

Promoting on-job training program for nurses


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Post-graduate year one(PGY1) program for physicians

This pilot program launched in August 2003 afterSARS outbreak for the first year resident

Purposes:

Providing hospital and community based training

Accumulating experiences for taking care forpatients from cradle to grave

Enhancing the first year residents acquisition of

detailed factual knowledge, the development ofclinical skills and professional competence ingeneral medicine


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Post-graduate year one

(PGY1) program for physicians

Curriculum:

General medicine: 36 hrs

Community medicine: 1 month

General surgery: 1 month

Internal medicine: 1 month

Residents should finish above courses

within one year


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Post-graduate year one

(PGY1) program for physicians

Outcome for the pilot program:

$NT 70,000 ($US 2,190) per month per resident

paid by government budget

60 teaching hospitals participated in the program

by 2004

95 physicians have finished the preceptor training

for PGY1 by 2004

1,419 residents finished the PGY1 training by Aug

2005


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Nurse Practitioner (NP) System



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Purposes of Establishing NP System in Taiwan

To upgrade the quality of medical services and

prevent and reduce medical errors.

To improve collaboration between physician-nurse

team work.

To readjust patient care tasks shared between

physician and nurse.

To improve physician-patient and nurse-patient

relation.

To establish a national standard for Training

Programs and Licensure System for NP to

ensure the high level of NP competencies.


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Major role:

To provide continuous and

integrated medical and nursing care

collaboratively with physicians.

Role of theNurse Practitioner


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Major Achievements of the Establishment since 2001:1. Has completed a report on recommendations

on the development of NP and relatedregulations

2. Has completed a pilot project on the training

program of NP and related regulations3. Has completed a project on the training of seed

clinical instructors for NP

The Development of NP System


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A Policy Proposal on

Training Program

Designing and Practice

Model for Nurse

Practitioners in Taiwan

(published by NHRI

Forum/Center on Health

Policy R&D in July 2004)


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Promulgated on Oct. 27, 2004 by the

Department of Health

Regulations Governing

Specialties and Examination of

Nurse Practitioner


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Chairman : Deputy Minister of DOH

Nursing experts

Medical experts

Director, Bureau of Nursing and Healthcare, DOH

Director, Bureau of Medical Affairs, DOH

Advisory Committee of the NP


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National Health Insurance (NHI)

Department of Health, Taiwan


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1950 Laborers Insurance

1958 Government Employees Insurance

1985 Farmers Insurance

1990 Low-income Household Insurance

1995 National Health Insurance

(Consolidating the health care component

of existing insurance programs into one)

Development of Social Insurance

Programs in Taiwan


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Major Achievements of NHI

Universal enrollment

Comprehensive coverage

Easy access

Affordable cost

Acceptable quality

High satisfaction


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99%

1%

Population Covered22 million (99%), 2004

Universal Enrollment

Staying abroad

In transition of jobs

Reluctant to join


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Inpatient care

Ambulatory care

Laboratory tests

Prescription drugs and certain OTC drugs

Dental services

Traditional Chinese medicine

Day care for the mentally ill

Home care

Some preventive services

Comprehensive Coverage


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Medical care institution contract

rate : 93%No. of physicians per 10,000: 16

No. of beds per 1,000: 60

Easy Access


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Total Health Expenditures as % of GDP, 1983-2003

6.26

5.99

5.91

4.934.81

5.27

4.774.67

4.204.00

4.104.003.90

4.00

3.80

3.70

5.335.275.29 5.465.44

3.593.443.39

1.65

2.932.76

1.85 1.892.00

2.94 3.06 3.14 3.02

0.440.450.51

0.81 0.82 0.81 0.77 0.69 0.59 0.470.51 0.47 0.46

2.23

2.121.82 1.77

2.21 2.1 2.18 2.16

1.81.82

1.851.96

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

7.0

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

% of GDP

Out-of-pocket

Health Insurance

Government Sector

Total Health ExpendituresNHI


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Worldwide Health Rankings

Taiwan

The Economist Intelligence Unit (2000)

Healthcare International, 2nd quarter 2000: 66-67, 72-75


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High Satisfaction(19982004)

Satisfied (DOH)

Satisfied (BNHI)

Dissatisfied (DOH)

Dissatisfied (BNHI)

76.60%78.60%

77.60%

76.30%70.90%

78.50%

71.1%

65.6%63.3% 63.8%

67.2%66.5%

61.0%

50.2%

39.0%

65.4%68.3%

59.70%

13.30%

36.5%

22.5%

23.4%

11.60%

17.00%

29.60%20.1%

25.9%

24.2%

24.5%

22.0%

27.0%

47.0%

20.60%15.90%

17.2%

13.60%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Sat is fied Dis s at is fied

05/95 09/95 06/96 01/98 04/98 11/98 05/99 03/00 10/00 06/01 12/01 05/02 11/02 07/03 12/03 04/04 09/04 12/04


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Cancer Control



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Changes of Main Causes of Death

crude death rate

590.28

crude death rate

950.80

1952 2004

Pneumonia

Tuberculosis

1

2

3

4

5

Malignant tumor

Cardiac disease

Gastroenteritis

Cerebrovascular diseases

Injury

DiabetesVascular disease of

central nervous system

0.1 million

(population)

Cardiac disease


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Five Leading Causes of Death

Rank Cause of Death Death %Adjusted MTR

(Per 100,000)

1 Malignant tumor 27.20 87.05

2 Cardiac disease 9.62 24.81

3Cerebrovascular

diseases9.23 24.42

4 Diabetes mellitus 6.88 19.17

5Accidents and

adverse effects6.32 29.32

Data resource: Ten Main Causes of Death Rate in 2004, Ministry of Health, the

Executive Yuan, TAIWAN


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Five Leading Sites of Cancer in Taiwan

Mortality (2004)

Liver Lung Colorectum Oral StomachM

44.92 443.03 19.76 15.94 14.17

Lung Liver Colorectum Breast CervixF

19.71 16.91 14.57 12.04 8.33

Incidence (2004)

Liver Lung Colorectum Oral StomachM

51.9 39.4 35.8 26.46 18.6

Breast Colorectum Cervix Liver LungF

39.6 27.9 23.73 20.0 18.3

Per 100,000


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Rationale for Screening Policy

WHOs suggestion on screening:

Cervical ca. and breast ca. screening are

effective

Colorectal ca. screening is partially effective

Incidence of oral and liver cancer is high in

Taiwan and domestic data proved screening is

effective


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Cancer Screening Programs

Sites Target Tool and Interval Starting year

Uterine

cervix

Women > 30 Pap smear;

NHI: 1 y; BHP: 3 y

1990 (DOH)

1995.07 (NHI)

Breast Women > 35 CBE by dr./nurse 1999-2001

(BHP)

High risk women50-69

MammographyFamily Hx: 1 y

Other high risk: 3 y

2002.07 2004.06 (BHP)

Women 50-69y Mammography 2 y 2004.07 (NHI)

Oral

cavity

Smoker, BN chewer

> 18

Exam of oral

mucosa; 3 y

1999 (BHP)

Colon-

rectum

General pubic 50-69 FOBT; 1 y July 2003

(BHP)


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Infrastructure of Screening

Delivery system of screening services

Accreditation program for cytology and

mammography

Computerized information system for each

cancer screening program


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Strategies

Establish evidence-based screening models Include screening in the National Health Insurance

Improve public awareness of early signs of cancers

Reduce screening obstacles and improve coverage

Establish an effective referral system for screeningpositive cases

Establish quality monitoring system for screening

Establish screening databanks for monitoring and

evaluation


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Disease Prevention and Control



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Strengthen Control System

Avoid Disease Threats

Surveillance

QuarantinePrevention

International

Cooperation

Research Infection

Control

Information

Management

Communicable Disease Control


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Immunization Program

Small pox vaccination started in 1906

DPT vaccination in 1954 Polio vaccination in 1966

HB vaccination in 1984


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Eradication of Communicable Diseases

Plague 1948

Smallpox 1955

Rabies 1959

Malaria 1965

Poliomyelitis 2000

N i l H l h C d C (NHCC)


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National Health Command Center (NHCC)


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Communication System Framework

National HealthCommand Center

Telephone-

conferencingfaxRadio

communication

system

Video-

conferencing

Each

BranchMass

Media

Public Health

Bureaus

Emergency

Medical

Network

Infectious

Prevention

Hospitals

Satellite

communicationTelephone

International

Organizations

WHO

US CDC

Computer :

Web-site &

e-mail


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The Platform for Information Integration

New Influenza

Cholera

Diphtheria EHEC infection

Meningococcal Meningitis

Enteroviruses infection

Complicated Severe Case

Dengue Fever

Japanese Encephalitis

Shigellosis Typhoid fever

Paratyphoid fever

epidemiological index1. stable 2. controlled 3. severe 4. extremely severe(2005/5/15-5/21)

score


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Preparedness ofInfluenza Pandemic

1. Possible effects of the next pandemic in

Taiwan >70,000 hospitalizations

>10,000 deaths

2. National Preparedness Plan of Influenza

Pandemic has been implemented.

3. Influenza Vaccine Self-manufacturing Plan

has been completed.

St t i i t


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Strategies againstNew-typed Influenza and Avian-Flu

Three strategies1. to bar transmission2. to reserve anti-virus drugs against influenza

3. to research and develop influenza vaccine

Four preventive measures1. to prohibit outside frontiers

2. to detect disease at borders3. to prevent and control within community4. to secure medical system


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Long-Term and Elderly Care

Services in Taiwan



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Population Growth Rate (1947-2004)

0

10

20

30

40

5060

1947 51 60 70 80 90 2004

Crude Birth Rate

Natural Increase Rate

Crude DeathRate

9.56

3.595.97

38.31

20.1818.15

49.97

38.40

11.57

38.87

32.03

6.83

27.16

22.26

4.90 4.76

18.63

23.38

16.5511.35

5.21


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Life Expectancy(1951-2004)

40

50

60

70

80

90

Years

56.33

53.38

79.41

73.60

Female

Male

1951 60 70 80 90 2004

76.7574.54

71.5666.40

71.3369.5666.66

62.31


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Long-Term Care System in Taiwan

Acute

medical care

Chronic

medical careLong-term care Rehabilitation

care

Skilled care Non-skilled care

Daily life

care

Medical care

Department of Health

Commission for Retired Servicemen

Ministry of the InteriorCommission for Retired Servicemen

Medical Care Act

Nurses Act

Welfare of the Elderly Act

Acute

hospitals

Chronic care

hospitals

Nursing homesHome health

care

Day care

Nursing careinstitutions

Home services

Day care centers

Foster institutions


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Pluralistic Care Systems for the ElderlyPluralistic Care Systems for the Elderly

health

prom

otio

n,health

health

prom

otio

n,health

mainten

ance

,preve

ntiv

e

mainten

ance

,preve

ntiv

e

health

care

services

health

care

services

emerge

ncycar

eservic

es

emerge

ncycar

eservic

es

medicalmedicalcenterscenters

regionalregional

hospitalshospitals

district hospitalsdistrict hospitals

healthhealthstationsstations

primary careprimary care

institutionsinstitutions

chronicdisease

chronicdisease

hospitalsandbeds

hospitalsandbeds

nursinghomeservice

nursinghomeservice

daycare

daycare

nursingcare

nursingcare

institutions

institutions

homecarefor

homecarefor

theaged

theaged

home carehome carein homein homeservicesservices

other social welfareother social welfare

and servicesand services

preventive healthcare servicespreventive healthcare services acute medical care services rehabilitation and after-care service

hhealth promotionealth promotion medical care network plan long-term care development plan


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05 International Disc Models Taiwan