Vol 23, No. 01, January 2019 |
Issue PDF view/purchase
Taiwan Medical Tourism
Known as a popular tourist destination in Asia, Taiwan is promoting its medical tourism industry. Read on to find out two hospitals with different specialties.
Taiwan is known for its popular pineapple cake, pristine national parks and busy night markets, and it is now adding medical tourism to the list. An island nation officially known as the Republic of China, it is still being compared to The People’s Republic of China, who claims to still have partial influence over Taiwan.
With a population of 23.5 million, it maintains a stable economic growth and is the fifth largest economy in Asia. Tourism contributes a huge role in its economy, attracting more than 10 million visitors in 2016, with tourists from China making up the majority (~3.5 million) as well as Southeast Asia, Japan and Korea.
Already a popular travel destination, Taiwan is now targeting its medical services to all. According to data from the Ministry of Health and Welfare, of its 22,612 hospitals and clinics in Taiwan in 2017 (483 hospitals and 22,129 clinics), 78 of its hospitals and clinics cater to medical services for international patients.
As a country that prides itself on its high-tech industry, Taiwan’s specialties are in the areas of liver transplantation, cardiovascular surgery, craniofacial reconstruction, joint replacement and artificial reproduction. At present, 14 of its hospitals have been accredited by the Joint Commission International (JCI), an international accreditation for healthcare quality and patient safety.
National Health Insurance
The current healthcare system in Taiwan is known as the National Health Insurance (NHI) which began in 1995 and revamped in 2013. The NHI is a compulsory single-payer social insurance plan that ensures equal access to healthcare for all citizens. The single-payer insurer monitors standards and use of medical services. It is mainly financed through premiums; the working population pays premiums split with their employers; some pay a flat rate with government help and the poor or veterans are fully subsidised. Under this model, citizens are free to choose their hospitals (private or public) and physicians without a gatekeeper and do not have to worry about waiting lists. There are no financial barriers to receiving the medical care and its citizens are less prone to bankruptcy as a result of medical bills. As premiums are regulated by the government, international visitors subsequently pay a lower fee to receive medical care in Taiwan compared to other developed countries.
Every enrollee to the NHI receives a Health IC smart card which is the size of a credit size and holds 32 kilobytes of memory. When an individual seeks medical services, the physician puts the card into a reader and the patient’s medical history and prescriptions can be accessed by both the provider and patient on a computer. This system helps to reduce insurance fraud, overcharges and duplication of services and prescriptions. After seeking medical services, the insurer is billed the medical bill and it is automatically paid.
Medical tourism refers to people traveling to a country other than their own to obtain medical treatment. Traditionally, people from less developed countries travel to major medical centers in highly developed countries for treatment unavailable in their country. However, in recent years, people from developed countries also travel to developing countries for reasons such as lower medical costs, medicals services unavailable or illegal in their home country, specialised treatments, better quality of care, shorter waiting period and advanced medical technology.
The single biggest reason patients travel to other countries for medical treatment is the opportunity to save money. Depending on the country and type of treatment, uninsured and underinsured patients as well as those seeking elective care can realise 15 to 85 percent savings over the cost of treatment at home.
Among all medical services provided, surgery (e.g. cosmetic) are the most popular. Dental and fertility services are also popularly sought after. People with rare conditions may also travel to countries where the treatment is better understood.
Taiwan’s healthcare costs
Healthcare services provided in Taiwan range from preventive health examination to surgical treatment and restoration. With some of the best advanced medical equipment (e.g. computer tomography, nuclear magnetic resonance, positron emission tomography) for examinations and follow-up treatments, still Taiwan’s medical costs are lower compared to Europe, America, South Korea and other developed countries.
A heart bypass cost around US$25,000 in Taiwan, US$70,000 in U.S.
A hip replacement cost around US$8,000 in Taiwan, US$33,000 in U.S.
State of medical tourism in Taiwan
According to Mr Walter Yeh, CEO and president of the Taiwan External Trade Development Council (TAITRA), some 305,600 foreigners visited Taiwan in 2017 to receive medical services. Visitors from Southeast Asia made up one-third of the foreign patients.
Yeh said the top five medical services most sought after are cancer treatment, artificial reproduction, cardiovascular surgery, minimally invasive surgery and health screening.
“Taiwan is equipped with advanced technology and high-quality medical services. At the same time, the cost of medical services is comparatively much more affordable and is quite competitively priced,” says Yeh.
In its bid to promote medical tourism in Taiwan, TAITRA assist Taiwanese businesses to connect with international firms.
Apart from bringing in overseas patients for medical attention, Yeh said TAITRA helps promote international medical services for Taiwan’s domestic hospitals and medical facilities. They also assist in arranging training programs for medical personnel from Southeast Asia to improve their local medical care and service quality and bringing in healthcare delegations to facilitate knowledge sharing.
Yeh shared for the future, TAITRA will continue to promote the highest quality of Taiwanese international medical services and technology in Asia. Taiwan wants to be the best choice for medical travel and these are two of its hospitals and their specialties.
Taichung Veterans General Hospital
Originally for military veterans, now for everyone
In central Taiwan, Taichung city with a population of 2.8 million, houses Taichung Veterans General Hospital (TCVGH). Originally founded in 1982 to provide medical services to military veterans from Mainland China, it has since expanded to also treat the public for various diseases, especially acute diseases, post-acute care, emergencies, organ transplants and diabetes management.
Dr. Wayne Huey-Herng Sheu, superintendent for TCVGH said veterans now make up 10 to 15 percent of the hospital’s patients.
In the earlier days, care for veterans was focused on acute diseases and disorders frequently found in aged patients, such as cardiac diseases, metabolic – endocrine diseases, and general internal diseases. In recent decades, although acute diseases are still predominant, malignant tumours are becoming common in hospitalised patients.
Now, TCVGH houses 1500 beds, 3900 employees, and handles 6,500 outpatient visits daily.
Apart from treating patients, it is also a public medical center by providing safe, high-quality medical services with advanced facilities and training programs as well as conducting research and development programs. In 1991, it was accredited as a “Medical Center and First Class Teaching Hospital” by the Ministry of Health and Welfare. The hospital also plays a role in training Taiwan’s doctors; of the total 40,000 doctors in Taiwan, 1300 sought training at TCVGH.
In 2017, TCVGH saw 3500 international patients for medical services ranging from minor surgeries (e.g. cosmetic), infertility, to major surgeries like hip replacement.
Dr. Sheu said that Taiwan, as well as many countries, face the same issue: as people age, they generally face more than one chronic illness (e.g. high blood pressure, diabetes), and treatment is often segregated. He shared an example, “Many elderly patients are admitted to the hospital for an acute condition, such as pneumonia. But they also suffer from other illness like diabetes or dementia. Often, physicians will treat the pneumonia but lack the resources to take care of the other conditions. Because pneumonia treatment requires the patient to be on bedrest for weeks, muscle atrophy will kick in, making the patient’s daily activities like eating or walking even more difficult. Many hospitals lack the resources to provide physical therapy to patients in acute care ward and this just adds on to the burden faced by the patient”.
He stresses the need for more integrated and holistic care for the elderly to relieve this healthcare burden such as that of TCVGH’s Center of Excellence in Diabetes Care.
Center of Excellence in Diabetes Care
One in 10 people in Taiwan is diabetic; this number is comparable to many countries in Southeast Asia. Diabetes, if not managed well, will lead to complications involving the heart, eyes, kidney, etc.
Dr. Sheu who specialises in diabetes mellitus, hyperlipidemia, and obesity and is also the president of the Chinese Taipei Diabetes Association (CTDA) said that diabetes is a good example of chronic care models. Many chronic diseases can mimic the care model of diabetes such as asthma, COPD, osteoporosis and chronic kidney disease.
As the first diabetes care center founded in 1997 in central Taiwan, TCVGH's Center of Excellence in Diabetes Care aims to provide joint care and education for diabetic patients in Taiwan, by integrating physicians, nurses, diabetes specialists, educators, and dieticians. Dr. Sheu remarked that the multiple disciplines and a lifestyle modification are necessary to take care of diabetes in addition to medication.
The center prides itself on every patient’s easy accessibility to the diabetes programs at the hospital. During the tour given by TCVGH, diabetic patients were seen seeking treatment for their condition all in one room, from measuring body mass index (BMI), to sudoscans to identify complications such as peripheral neuropathy, and even receiving advice on diabetes prevention.
Apart from being a medical center and providing clinical services to diabetic patients, it is also a research and teaching hospital. It conducts basic research focused on identification of genes related to the pathogenesis of diabetes mellitus and its complications, and the effects of micronutrients on mice and humans. In clinical research, their interest is in diabetes mellitus, thyroid disorders, obesity, and hypertension. The hospital actively participates in international clinical drugs trials to test new drugs and new regimens in the area of diabetic treatment. They also conduct training programmes for its medical students and resident doctors, regularly holding conferences with other departments (radiology, pathology, general surgery etc) to build a holistic healthcare system for its patients.
They have developed a web-based patient management platform for diabetes care. For instance, a dashboard helps to remotely identify all inpatients with poor glucose control. In addition, virtual glucose management service has been established for glucose control in hospitalised patients with diabetes or hyperglycemia.
The hospital is also known for its efficient use of technology. Medical service robots were seen to assist the information counters at the hospital, and cashiers were replaced by medical payment machines.
TCVGH has also developed its own smart reminder system for their physicians. This system can be used for error prevention, for instance, reminding physicians of the drug-to-drug interactions to prevent negative consequences, ensure the proper use of antibiotic and prevent antibiotic resistance.
Dr. Sheu wants to dedicate himself to making TCVGH a leading-edge smart hospital, emphasising information technology, advanced medical technology, outstanding medical quality and excellent patient safety.
China Medical University Hospital: Taichung, Taiwan
Where Chinese and Western medicine merge
Taichung is also home to another hospital, the China Medical University Hospital (CMUH). Affiliated to the China Medical University (CMU), the hospital was founded in 1980. The university was the first academic institution in Taiwan where Traditional Chinese Medicine (TCM) and western pharmacy programs were offered and so its hospital is also competent in both areas.
Currently, CMUH houses 2000 beds, 5000 employees and 6300 outpatients visit daily.
As a JCI accredited hospital, it is also an integrated medical center and research center with strong developments in biomedicine.
Cancer has been the leading cause of death in Taiwan with 4.5 million people diagnosed and approximately 100 people dying from cancer daily. In Taiwan, oral cancer is one of the top cancers in both males and females due to the high prevalence of betel nut chewing and cigarette smoking.
The disease characteristics and progression of cancers may vary widely. The professional views on the diagnosis, clinical stages, and treatment of cancer can also differ. Although early diagnosis is still viewed as a key element to treatment success, people continue to have the misperception that treatments of terminal stage cancer is rarely effective, which has led many people to believe that cancer is incurable. However, with the recent advances in medicine and biotechnology, more than one half of cancer patients can now be cured (Taiwan’s overall cancer cure rate ~55 percent).
One medical center of CMUH is its Cancer Center, established in 2007. It provides a comprehensive service through its multidisciplinary physicians and expertise in the field of lung, breast, head and neck, cervical, liver, colorectal, esophageal, stomach, pancreatic, and paediatric cancers. The center treats 5500 cases of newly-diagnosed cancer each year. Because screening is important, the center is also one of the leading centers in Taiwan for community cancer screening.
The center features molecular targeted drug therapy, video-assisted minimally invasive surgery, da Vinci robotic surgery, organ transplants, and radiotherapy services. It is also the first in Taiwan to build a Heavy Ion Therapy Center to treat hard-to-cure cancers such as pancreatic cancer or bone cancer, which before patients had to seek medical treatment abroad.
As a research center, it also conducts clinical trials and translational research in collaboration with top institutes worldwide including the M D Anderson Cancer Center in U.S.
He has trained nearly 200 surgeons worldwide from the most basic cases to challenging cases through his innovative microsurgical methods such as the use of laparoscopic surgery to harvest intestines for voice reconstruction, reconstruction of the vagina with the small intestine (jejunum) and reconstruction of the cervix with the cecum and appendix.
In recent years, with help from the Ministry of Economic Affairs, the Ministry of Foreign Affairs, TAITRA and other institutions, the center has joined efforts in international humanitarian work, such as providing surgeries for patients with rare deformities.
In 2016, the center operated on Nguyen Thi Loan, a young Vietnamese girl with multiple deformities of the genitalia and vascular malformations of the lower gastrointestinal tract.
The center has also conducted surgeries on bedridden patients from Peru with advanced stage congenital lymphedema of the lower limbs, which were met with success.
In the most recent operation with Let, an 11-year-old girl from Myanmar in 2018, Dr. Chen called upon a multidisciplinary medical team consisting of E.N.T., ophthalmology, neurosurgery, cosmetic surgery, thoracic surgery, orthopedics, and 3D medical printing. It took eight months to complete a three-part surgery that included abnormal tissue resection and auricle and right face reconstruction, to resolve Let’s rare congenital defect called the Goldenhar Syndrome.
Over the past five years (2013 to 2018), the center has treated a total of 28 international cases of rare deformities from countries like China, U.S., Vietnam, Philippines, etc. The center hopes to continue providing international medical humanitarian relief in the hopes of bringing medical treatment to those in need.
This article was derived from the Medical Media Delegation for Taiwan Healthcare 2018, held from 27 to 30 November 2018 in Taiwan. Sponsored by the Ministry of Health and Welfare of Taiwan, and organised by the Taiwan External Trade Development Council.