Health _ Medical Ethics in Taiwan

Health & Medical Ethics in Taiwan New Century, New Challenges & New Thinking Tzu Chi University, TAIWAN Chung-Fu Lan Approaches (Issues/Challenges) I. Scenarios Analyses (agenda) II. Strategic Thinking, Planning, & Management (Priority Setting/Resources Allocation) III. Options & Choices Changing Healthcare Environment in Taiwan Drastic Changes in Taiwan’s Healthcare Environment • Dominance of the National Health Insurance program (especially the reimbursement system, e.g., case payment & global budget) on healthcare expenditures, resources development & healthcare ecologies • Massive expansions of large medical centers/chains (beds & equipments) & healthrelated schools; phasing out of some small & medium-size hospitals, clinics & medical specialties • Demands for health professionals to meet the need of the market-driven healthcare system & to catch up with the progress of new technology & information development • Public expectation on higher quality services at lower cost; also growing demand for comprehensive health & social care in an aging Taiwan • Trade-offs between academic/clinical & gown/town in academic medical centers • Trust among healthcare consumers, providers & insurers continues to ebb lower • Ethical dilemmas in healthcare everincreasing with the advancement of medical and information technologies Examples of Ethical Issues in Taiwan’s Healthcare • • • • • • Test-tube babies, Cesarean operation, etc. Teenage pregnancy & abortion Higher ratios on hemodialysis, Dx tests, etc. End-of-life care (life-sustaining to hospice) Brain death & organ transplantation Human subjects experimentation & clinical research Major Forces & Influences for Health & Medical Ethics In Taiwan • Value changes regarding to the life & the society • Changes in population structure • Ever-expanding role of government: through financing & regulation • Technological advances in medicine & information • Involvement of financial, industrial & religious capital: the business of medicine • More knowledge & questioning public: challenging traditional medical care practices 7 interests • Conflicts of different schools in medical practices & healthcare reform: – – – – Traditional Chinese Japanese American European Changes & Impacts on Taiwan’s Physicians & Hospitals Planned Market & Physician Behavior • Too many physician yet maldistribution in medical specialties • Continuing medical education & renew license • Practice styles & clinical practice guidelines • Postgraduate training in health policy, management & law • Strengthen the role medical societies Managed Competition & Hospital Behaviors • Appropriate size / appropriate mission • Diversification, integration & strategic alliance (including mergers & closures) • More capital investment & business-like management • Cost containment & quality improvement • Hospital accreditation linking with hospital & physician payments New Century, New Scenarios & New Challenges in Healthcare Future Scenarios I • Personalized (one-to-one services) medicine • Socialized medicine => Population-based Medicine Future Scenario II • Primary & Specialty Care Medicine • Hospital-based Medicine • Preventive & Long-term Care Medicine => Horizontally & Vertically Integrated Medicine Future Scenario III • Professional-autonomous Medicine • Cost-contained & Quality-assured Medicine • Defensive Medicine => Organized & Managed Medicine Future Scenario IV • • • • Fee-for-service Medicine Case-payment Medicine Global-budget Medicine Profile-based Medicine =>Evidence-based Medicine & Reimbursement Future Scenario V • Disease-specific Medicine • Specialty-specific Medicine • Technology-intensive Medicine => Genomic Medicine Future Scenario VI • • • • Person-to-person Medicine Face-to-face Medicine Office-based Medicine Information-intensive Medicine => e-Medicine (B2B, B2C & C2B, C2C) Epilogue: Strategic Thinking for Healthcare System’s Future Fundamentals for Taiwan’s Healthcare System • Rethinking of: – values in health & medicine – philosophy & objectives of medical & allied health professional education – rights & responsibility for clinical decisionmakers – duty to the patient & to the society • Rebuilding of: – – – – morality in medicine & healthcare healthcare delivery healthcare finance trust among the consumer, the provider & the insurer in healthcare • Rebalancing at: – – – – – – public expectations & limited resources scientific advancement & clinical excellence quality & cost in healthcare health education & information development clinical & managerial decision-making medical ethics & new technological progress Many Thanks!!!