Public Health

In a ranking made by The Economist magazine on the quality of health care in advanced industrial and newly industrialized countries, Taiwan placed second behind only Sweden.

Shifting demographic patterns and changes in modern lifestyles have affected health care in Taiwan. For instance, Taiwan’s rapidly aging population has highlighted long-term care for the elderly, while serious pollution and smoking problems have triggered public health concerns.

The control of infectious diseases in Taiwan has greatly improved. Bubonic plague, smallpox, and cholera were eradicated long ago, and not a single case of rabies has been discovered since 1959. In 1965, the World Health Organization (WHO) declared malaria nonexistent in Taiwan. Other infectious diseases, such as diphtheria, whooping cough (pertussis), neonatal tetanus, poliomyelitis, Japanese encephalitis, and tuberculosis, are all under strict control now.

The health of the general population has also greatly improved over the past few decades. Average life expectancy from 1951 to 2002 has increased from 53.38 years to 73.03 years for males, and from 56.33 years to 78.82 years for females. The crude death rate was 5.73 per 1,000 persons in 2002, and the infant mortality rate dropped from 44.71 per 1,000 live births in 1952 to 5.29 per 1,000 live births in 2002.

Medical Personnel

At the end of 2002, there were more than 175,444 medical personnel in the Taiwan area. On average, there was one doctor of Western medicine for every 632 persons, and one dentist for every 2,446 persons. Physicians may apply for a medical specialist license that is valid for five to six years, and can renew this license after undergoing a short period of training in the latest advances in knowledge and technology.

Personnel imbalances are a major problem for Taiwan’s medical care system. The lack of qualified medical personnel in rural and remote areas has prompted the government to offer increased pay and commuting subsidies as incentives to medical personnel willing to serve in these areas. In addition, beginning in 1999, medical school graduates who have studied on government scholarships are required to serve in a remote area or special medical branch for at least one year. The government also provides transportation subsidies for patients requiring a transfer to a city.

Foreign nationals with licenses recognized by the ROC government may apply to take a written exam in Chinese that would allow them to obtain a license to practice medicine in Taiwan. As of 2002, there were 265 physicians, 63 dentists, and 22 pharmacists from overseas providing services in Taiwan.

Medical Facilities

An extensive network of hospitals and clinics serves the people in the Taiwan area. At the end of 2002, there were a combined total of 18,228 public hospitals, private hospitals, and clinics in Taiwan providing 133,398 short-term and long-term care beds, or an average of roughly 53 beds per 10,000 persons. Public medical care institutions consisted of 91 hospitals and 490 clinics. Private medical care institutions consisted of 483 hospitals and 8,812 clinics.

Health Stations

Residents in mountain areas and offshore islands rely heavily on local health stations, health rooms, and small-scale health posts for medical services, general outpatient treatment, and emergency medical care. By the end of 2002, there were 371 health stations and about 500 health rooms throughout the Taiwan area.

Health stations, which are community-oriented and form the basis of primary health care in the Taiwan area, are usually staffed with physicians, dentists, pharmacists, nurses, and laboratory technicians. On average, every health station has at least one or two doctors, and even health stations and health rooms in remote areas have basic medical equipment such as regular and dental x-ray machines. In addition, almost all group practice centers are equipped with automatic biochemical analyzers. Surveys show that 70 to 90 percent of all visits to community health stations are for infant or child immunizations.

Health stations with supporting high-tech equipment for strengthening emergency medical care services have been set up in areas with limited medical resources. This includes 49 health stations established in 30 indigenous townships scattered throughout 12 counties in Taiwan proper; the Pescadores; Liouciou Township in Pingtung County; and Green Island off the coast of Taitung. Approximately 200 health rooms have also been set up to serve residents in relatively inaccessible areas.

Health Insurance

In view of Taiwan’s rapidly growing medical care costs and rising number of elderly, the ROC government launched the National Health Insurance (NHI) program on March 1, 1995, to provide universal medical care. The NHI system incorporated the medical insurance coverage provided by Taiwan’s original 13 public health insurance plans and further extended the coverage to the 7.99 million citizens who were formerly uninsured, mainly the elderly, children, students, housewives, and the disabled. At the end of 2002, there were 21.87 million persons covered by the NHI program, or 96 percent of Taiwan’s total population of 23 million. Participation in the NHI program is mandatory for all ROC citizens and foreign nationals with Alien Resident Certificates who have resided in Taiwan for more than four months.

The coverage provided by the NHI program is very comprehensive and includes inpatient care, ambulatory care, laboratory tests, x-ray examinations, pharmaceuticals, dental services, traditional Chinese medicine, daycare for the mentally ill, and limited home health care. Four preventive services─adult health examinations, pre-natal examinations, well-baby checkups, and Pap smear examinations─are also covered under the NHI program, as are several expensive treatments such as cocktail therapy (for treating HIV-positive patients) and organ transplants.

In September 2002, the NHI premium rate was raised from 4.25 percent to 4.55 percent to reflect an increase in medical expenditures. In addition, the insurable income of the top level was increased to five times more than that of the bottom level. Under this new structure for NHI premiums and rates, private enterprise employees now have to pay 30 percent of the premium, employers must pay 60 percent, and the government pays 10 percent.

Major Health Problems

As the ratio of elderly people in society increases, chronic cardiovascular diseases have replaced infectious diseases as the major causes of death among adults. In 2002, for instance, cerebrovascular diseases, heart diseases, and diabetes mellitus were the second, third, and fourth leading causes of death, respectively, representing 25.42 percent of all deaths that year. Suicide became the ninth leading cause of death for the first time in 2002.

Cancer Control

Cancer has been the leading cause of death in the Taiwan area since 1982 and claimed 34,342 lives in 2002. The five most common forms of cancer for Taiwanese men are liver, lung, colorectal, stomach, and oral cancer, and for women, lung, liver, colorectal, breast, and cervical cancer. To lower the death rate and strengthen the early detection of cervical, breast, and oral cancer, the Department of Health (DOH) 衛生署 has formulated a community cancer-screening spot check plan. Since July 1, 1995, the NHI program has covered cervical smear tests for all women over the age of 30.

Communicable Diseases

A surveillance network has been set up to report communicable diseases in Taiwan, with participating physicians providing weekly updates to the network via phone, fax, or mail. The latest information and medical updates are then made available to other physicians in the monthly Epidemiology Bulletin 疫情報導, which is circulated to medical centers around the island. Currently, six disease surveillance centers and quarantine stations under the National Quarantine Service have been set up in Keelung, CKS International Airport, Taichung, Hualien, Kaohsiung, and Siaogang International Airport.

Enterovirus

An outbreak of enterovirus in 1998 claimed 78 lives and caused a panic among parents, since all of the victims were below the age of 15. In 1999 there were 35 cases of the disease and nine deaths, and in 2000, another 41 lives were lost from 291 confirmed cases of the ailment. The disease spread rapidly in 2001, with 618 discovered cases, 393 confirmed cases, and 58 deaths; however, close supervision by the government and cooperation from parents helped to bring the disease under control again, and in 2002, there were only 315 discovered cases, 162 confirmed cases, and 30 deaths.

AIDS

The Acquired Immune Deficiency Syndrome (AIDS) Control Act 後天免疫缺乏症候群防治條例 was promulgated in December 1990 to provide free screening and treatment for patients, as well as to deal with cases involving HIV-infected individuals who knowingly passed the disease to unsuspecting victims. Screening usually involves blood tests to check for the human immune deficiency virus (HIV) antibody. In 2002, a total of 830 people were diagnosed as being HIV positive and another 178 were confirmed AIDS patients, all ROC nationals. According to DOH statistics, the typical male HIV carrier in Taiwan is single, employed, 33.7 years old, and frequents prostitutes, whereas the typical female HIV carrier is usually a married housewife around 35 years old who has been infected by her husband.

Hepatitis

Between 15 to 20 percent of Taiwan’s total population is infected with the hepatitis B virus. Liver cancer, which has been linked to hepatitis, has for years been the number one killer in Taiwan. Consequently, a comprehensive immunization program covering all newborns, preschool children, elementary school children, young adults, medical personnel, and family members of carriers was initiated in 1984 to help control the spread of the disease, making Taiwan the first nation in the world to implement a hepatitis immunization program. The results were a great success, with one study showing that hepatitis B carriers under six years of age had dropped to an all-time low of 1.7 percent, while hepatitis A cases dropped from 851 cases reported in 1995 to 98 cases in 2000, of which only 68 were confirmed cases. In recent years, however, hepatitis A has been on the rise again with 268 reported cases and 257 confirmed cases in 2001, and 217 reported cases and 212 confirmed cases in 2002.

Tuberculosis

In 2002, there were 21,861 discovered cases of tuberculosis (TB), 14,250 confirmed cases, and 1,277 deaths from TB, or a death rate of 5.68 per 100,000 persons─which, compared with the statistics of other nations, is considered a fairly high infection and death rate. Consequently, a five-year project to lower the infection rate and bring TB under control has been undertaken by the government that includes refurbishing treatment facilities, controlling chronically active cases, and implementing a surveillance system for high-risk TB groups, especially in indigenous communities.

SARS

Severe acute respiratory syndrome (SARS) originated in China and first spread to Taiwan on March 14, 2003, owing to the cultural and geographical connection between the two sides. The government of Taiwan immediately adopted control measures to contain the epidemic, including quarantining those who had had contact with suspected SARS patients, implementing a compulsory ten-day quarantine for all passengers arriving from areas with recent local transmissions, designating several hospitals and military barracks in advance to be used as separate medical centers for the treatment of suspected SARS patients, and encouraging everyone to wash their hands regularly and measure their temperature twice per day.

As of June 2003, Taiwan had 676 probable SARS cases, 1,374 suspected cases, and 81 deaths as a result of the disease. Thanks to the joint efforts of the government and people, Taiwan was successfully removed from the WHO’s SARS travel advisory watch list in July 2003.

Pharmaceutical Regulation

All medicines and medical devices, whether imported or locally produced, must be registered and licensed by the DOH before they can be marketed in the Taiwan area. Local health authorities routinely conduct unscheduled inspections of the medicines and cosmetics that are manufactured, imported, or sold in their areas, and the manufacturers and purveyors of such goods that fail to pass inspection are punished in accordance with the Pharmaceutical Affairs Law 藥事法 and the Cosmetics Sanitary Control Law 化妝品 衛生管理條例.

To help maintain the integrity of its pharmaceutical industry, ensure the quality of drug products on the market, and guarantee the safety of new medicinal products, Taiwan has established an ongoing Good Manufacturing Practices (GMP) monitoring system. As of 2002, the DOH and the Ministry of Economic Affairs had jointly issued the GMP seal to 194 certified pharmaceutical factories.

In January 1999, the Key Points for Drug Injury Relief 藥害救濟要點 was formulated to safeguard the interests of patients and pharmaceutical manufacturers, and in May 2000, the Law of Drug Injury Relief 藥害救濟法 was promulgated to extend this relief to cases related to Chinese medicinal products and treatments. A relief fund was also established to provide financial aid to those injured from drugs.

Traditional Chinese Medicine

Chinese medicine is as valued today as it has been for thousands of years and is enjoying new respect from modern western medical researchers. In Taiwan, the main research organization specializing in traditional Chinese medicine is the Committee on Chinese Medicine and Pharmacy (CCMP), whose members are selected from the nation’s most distinguished practitioners of Chinese medicine. As of December 2002, there were 36 Chinese medicine hospitals, 2,601 Chinese medicine clinics, and 4,101 licensed doctors of Chinese medicine in the Taiwan area.

Today, Taiwan remains at the forefront of research on Chinese medicine, acupuncture, and other Chinese medical practices. Many research projects are conducted in Taiwan to evaluate the effects of Chinese medicine and acupuncture on various types of illnesses and diseases, and these findings are routinely compiled in the Chinese Medicinal Yearbook 中醫藥年報 published regularly by the DOH. Information on Chinese medicine can be obtained online at http://www.ccmp.gov.tw, or by sending electronic mail to webmaster@ccmp.gov.tw.