How Taiwan transformed its health care system • Hacker News Board

Re: How Taiwan transformed its health care system

#51

Post by calcifer » Sun, Dec 31, 2017, 12:20 PM UTC

gurkendoktor wrote: post #46

For balance, this is a good summary of the issues that Taiwan's NHI system faces: https://english.cw.com.tw/article/article.action?id=1662 It matches the complaints I've heard from several nurses quite well. Idiots with a harmless common cold clog hospital waiting rooms just because it's cheap and convenient. Not just doctors, but also nurses are underpaid and will jump ship if they can.

Indeed. I prefer the Dutch system. Here, if you go to a hospital without a) being sent there in an ambulance via a 112 call or b) being referred by your GP ("huisart") insurance won't cover anything. It works wonders for keeping idiots from emergency rooms.

Re: How Taiwan transformed its health care system

#52

Post by nerdponx » Sun, Dec 31, 2017, 12:28 PM UTC

ImaCake wrote: post #19

peterburkimsher wrote: post #12

Culture helps - everyone here wants to be a doctor, lawyer, or engineer. Taiwanese doctors don't get paid in money. They get paid "credits" which have to be exchanged for money based on a parallel financial system. Foreigners here sometimes complain that there's a focus on seeing more patients faster, so there might be a misdiagnosis or a less thorough examination. The fact remains though - it's cheaper to fly here t…

I have encounted free general practice doctor places in Australia that operate on seeing as many patients as possible. Basically useless if you have a difficult to diagnose problem, but very useful for getting a referal, a script for a pill, or antibiotics.

This is how many GP offices work in the USA as well, especially in urban areas or offices associated with hospitals.

Unless you already know what kind of specialist you need to go see, and you can afford to go see the right one (might involve multiple visits to multiple specialists), you might literally never get help for a chronic problem that is not obvious on a differential diagnosis.

There really needs to be two kinds visits available: quick visits and check ups, and diagnostic visits. The first can be over in 10 minutes, the latter should last a solid hour.

I'm starting to wonder if "diagnostician" should be a separate specialization. Then I could make an appointment specifically to go see the diagnostician, and not bother the general practitioner, who is evidently too busy to spend more than 15 minutes diagnosing something.

Re: How Taiwan transformed its health care system

#53

Post by distances » Sun, Dec 31, 2017, 1:12 PM UTC

LammyL wrote: post #25

peterburkimsher wrote: post #12

Culture helps - everyone here wants to be a doctor, lawyer, or engineer. Taiwanese doctors don't get paid in money. They get paid "credits" which have to be exchanged for money based on a parallel financial system. Foreigners here sometimes complain that there's a focus on seeing more patients faster, so there might be a misdiagnosis or a less thorough examination. The fact remains though - it's cheaper to fly here t…

How much does it cost to get wisdom teeth removed in the US and in Taiwan? My dentist in Toronto charges around $400 CAD per tooth for extractions, and that’s with full general anesthesia. The price is the same here with private insurance and without.

I'm wondering the same. In Germany my wisdom tooth removal took 20 minutes with local anesthesia included. It was fully covered by the regular compulsory health insurance so I don't know the cost, but seems like quite a small operation to me.

Re: How Taiwan transformed its health care system

#54

Post by yorwba » Sun, Dec 31, 2017, 1:14 PM UTC

whatyoucantsay wrote: post #50

kevinjcliao wrote: post #24

Earlier quoted context omitted.

Hi there! Taiwanese here. We invented boba (full of sugar and unhealthy), and our cuisine, while delicious, can be incredibly unhealthy. We are actually struggling to confront one of Asia's largest obesity epidemics. I think the notion that we're an island "full of thin people who eat rice or noodles at almost every meal" is not only a problematic and reductionist characterization, it ignores the problems that we fac…

Hi, there! Your comment is charactaristically un -Taiwanese, starting with the word "boba". That isn't the word people use for it in Taiwan (either in meaning of the characters or the sound). Most people don't understand boba (波霸) and I personally never encountered the word until visiting North America. In Taiwan, it's 珍珠奶茶. > "people who eat rice or noodles at almost every meal" is not only a problematic and reducti…

I don't consider it surprising that a Taiwanese would use characteristically un-Taiwanese expressions on an English-language forum. I'm not sure what to think of your approach of suggesting that they are lying, but then self-congratulating your charity for not outright saying that.

While rice and noodles may be staples of Taiwanese food, that doesn't mean that everyone is eating healthy. In the West, you might say the same about wheat flour and potatoes, but when that flour comes in the form of burger buns and cake, and the potatoes in greasy fries, it doesn't seem so healthy.

I don't know how often Taiwanese drink sugary drinks or eat sweets in addition to their meals, nor do I know how much of that rice and those noodles are fried as chow fan or chow mein (and apologies if those are not the words Taiwanese would use), but it isn't hard to imagine that it is more than optimal. That's usually what happens when people are able to afford more food than they actually need, and are able to choose tasty high-calorie high-fat meals whenever they feel like it.

Re: How Taiwan transformed its health care system

#55

Post by digi_owl » Sun, Dec 31, 2017, 1:26 PM UTC

sytelus wrote: post #31

This is interesting because there is so much conflicting information. On one hand several people mention they received timely inexpensive care in single-payer system and on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option. It appears that Taiwan's system is certainly getting stretched now and they have been putting up new constraints and ca…

> on other hand there are example of people who were told to wait in line for weeks or get denied of their desired treatment option.

These seems to most often crop up around non-critical issues like joint paints etc.

And i have yet to find a single payer system that do not let you go abroad for elective care, if you can find the funding. They will however not fund your trip unless there is a strong case made for there being no viable alternatives back home.

Re: How Taiwan transformed its health care system

#56

Post by digi_owl » Sun, Dec 31, 2017, 1:29 PM UTC

sjg007 wrote: post #48

fleitz wrote: post #45

Earlier quoted context omitted.

Yup, the idea for for profit driven healthcare sounds bad until you consider the alternative which is cost minimization driven, the easiest way to cut costs is to not provide service

It’s the same doctors regardless... insurance companies are cost minimizers as well.

Indeed. My understanding is that US hospitals will inflate their bills because they know the insurance companies will turn over every stone to find ways to drive the bill down.

This in turn bites those that try to pay directly, as they end up with sticker shock.

Re: How Taiwan transformed its health care system

#57

Post by mtanski » Sun, Dec 31, 2017, 1:36 PM UTC

adventured wrote: post #39

diziet wrote: post #22

Earlier quoted context omitted.

When I visited Taiwan, I needed to get some urgent dental care done. I went to a small local clinic, where the dentist spoke good enough english, did great work (including x-rays) and my total uninsured bill was less than my co-pay in the US would have been. It is good AND affordable.

The average American dentist earns $175,000, the median is ~$155,000. What do you propose to do about that to reduce their income considerably to bring down overall costs vs what a dentist in Taiwan earns? US GDP per capita is nearly three times that of Taiwan, incomes are likewise far higher. It's equivalent to comparing costs in Switzerland versus Czech and being surprised that Switzerland is so much higher.

Price controls is a dirty term we refuse to talk about in the good 'ol USA. Most other healthcare systems in the world with low prices have some kind of combination of it when it comes to drugs and procedures performed. The AMA has been fighting any kind of single payer system for 50 years now. They know that a single payer system will result in some kind of price controls. On one hand you understand their point of view (maximizibf their income well being) and on the other hand you understand the issue with that for all of society.

Having said that it's not just the income of doctor. Healthcare administration is expensive in the USA. Many doctors offices spend a non insignificant amount of money on just the billing, collection, insurance administration. The health insurance system as we naturally ended up with sucks up a non insignificant amount of money out of the system. It also leads to these weird distortions where every insured procedure is discounted to the insurance agency like 75%... But not if you deal direct.

Additionally, operational insurance (malpractice indurance) is another non-insignificant contributor. Our culture and our legal system ensure that many doctors practices will pay a multiple of a practitioners salary in malpractice and related salary.

If we want cheaper healthcare all of these need to be addressed one way or another. I am not hopeful that we can escape this local maxima that we're stuck in. Every attempt at change will be meet with fierce opposition from the current status quo.

Re: How Taiwan transformed its health care system

#58

Post by [deleted] » Sun, Dec 31, 2017, 2:05 PM UTC

netsharc wrote: post #43

xwvvvvwx wrote: post #32

Earlier quoted context omitted.

> Taiwanese doctors don't get paid in money. > They get paid "credits" which have to be exchanged for money based on a parallel financial system. This is really interesting. Had a quick google and couldn’t find anything. Do you have a link with more details?

Maybe they get paid with blockchain-based currency. (I kid..) Maybe he means doctors get paid with status, and if you're a doctor you get better rates for loans.

[deleted]

Re: How Taiwan transformed its health care system

#59

Post by Symbiote » Sun, Dec 31, 2017, 2:08 PM UTC

distances wrote: post #53

LammyL wrote: post #25

Earlier quoted context omitted.

How much does it cost to get wisdom teeth removed in the US and in Taiwan? My dentist in Toronto charges around $400 CAD per tooth for extractions, and that’s with full general anesthesia. The price is the same here with private insurance and without.

I'm wondering the same. In Germany my wisdom tooth removal took 20 minutes with local anesthesia included. It was fully covered by the regular compulsory health insurance so I don't know the cost, but seems like quite a small operation to me.

That cost me €500 in the centre of Copenhagen, there are probably cheaper dentists in Denmark.

It took a bit longer for me, a second dentist came to help towards the end.

Re: How Taiwan transformed its health care system

#60

Post by Symbiote » Sun, Dec 31, 2017, 2:17 PM UTC

sytelus wrote: post #44

yellow_postit wrote: post #40

Earlier quoted context omitted.

With most US based insurance being employer based I don't see how the "we only cover x because of y" really is a discriminating function between single payer vs multiple. My ability to choose an employer based on their health care plan is challenging at best. I may be missing something however as I mostly know the US system

If you have good top tier employer, chances are that you have pretty good insurance. Medical insurance is actually a criteria for lot of people for which employers to work for. This however probably applies to more skilled workers who have such choices. In single-payer, your employer no longer provides insurance. So everyone gets same plan and you are stuck with it.

A top tier employer in Europe may still offer private health care insurance.

When my father had cancer treatment, he sometimes asked for the public hospital (shared ward, less lonely when he was feeling OK but had to spend days in a bed) and other times the private hospital (doctors and nurses had more time, but the treatment was the same and he had a private room).