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The University of Texas ― M.D. Anderson cancer center professor Euishin Edmund Kim, M.D. urged Korean people don't waste their energy flying to the US for medical treatment, because Korea's medical tech. is as good as any other country's.   An article (Apple Daily, Taiwan, 6-22-2015) by Taiwan's Veterans General Hospital physician Dr. Ton (唐宗詠) points out that so many Taiwanese expatriates living abroad (with permanent resident card) and/or  foreign citizens of Taiwanese origin flied a long way back to Taiwan for medical treatment. ――  Taiwan's medical-insurance system costs them much less than that in other countries, e.g.,  the price for a plaster cast in USA  almost equals one month salary of a Taiwanese orthopaedics resident-physician, so, some Taiwanese or Taiwanese American, etc, would rather bear the pain caused by their illness and long-distance trip to save lots of their money. http://www.appledaily.com.tw/realtimenews/article/new/20150622/633042/  (包山包海包全球的台灣健保)   Washington Post at 3-1-2019 named Taiwan's health-care system "socialized medicine", Taiwan is less wealthy than the US, yet it spends less and gets more,  the amount costs for a course of Harvoni treatment and C-section is  $32,114 and $15,106 respectively in the Us, but $2,132 and $1,404 in Taiwan.   An American in Taiwan getting stomach flu was checked within 20 minutes of his arrival (ref. to https://www.washingtonpost.com/health/2019/03/01/an-american-got-sick-taiwan-he-came-back-with-tale-horrors-socialized-medicine/) .  The Liberty Times (5-5-2019) : The number of foreign patients coming Taiwan for treatment etc hits new high, 110 thousands more than that of the previous year.

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Taiwan's medical & health performance is so successful (e.g. life expectancy, infant mortality and maternal mortality, are better than U.S., although we spent only one-quarter of USD (PPP) in health expenditure.) that former leader of health government, Dr. Ye Ching-chuan, was invited to testify at an US senate committee hearing on this issue  (http://blog.udn.com/yestaipei/18685477) .  An article by China Medical University (Taiwan) Professor Ma (馬文隆)  stated Taiwanese studies on liver cancer lead the world in the past   (http://gicm.cmu.edu.tw/adv.html )  also proves Taiwan's medical tech. is as good as most countries in the world.

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However,  Apple Daily 7-17-2019: Taiwan's healthcare system is on the brink of "bankruptcy" in 2026, the government's allocation of funds for urgent need is no more than curing the symptom instead of curing the disease.   Next TV news (5-25-2019, 20:44 / 壹新聞  壹電視) reported that Taiwan government kept adjusting the price of more and more drugs to cover the deficit of medical insurance system, which resulted in more and more brand drugs withdrawing from Taiwan (e.g., TIENAM) , because cheap-price generic drugs made in Taiwan are not as curative effective as brand drugs, physicians worry there's no good medicines for patients ...  Besides, Apple Daily (6-4-2017): Taiwan medical service's critical problem ―― Preventive Health-Care service is behind.   The China Times, (7-4-2017) : "patients centered" is nothing but a slogan. 

According to WEF<Travel and tourism competitiveness report> (released at 4-6-2017), Taiwan's "Physician density" ranks world No. 65 (No. 57 in 2015's report).   Apple Daily 6-30-2018 pointed out Taiwan's only pride left, health insurance, includes no preventive health care and health promotion, and will worsen within next 10 years for political factors.   Taiwan only ranks world 45th position in Lancet's Healthcare Access and Quality Index released in 2017 (based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study   2015),  some chronic disease items got very low scores, e.g.,   Leukemia score 49,  Kidney disease 50, Gallbladder & biliary 57, Hypertensive Heart Disease 60,   diabetes mellitus 58, etc.  Please ref. to the table as below:

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30818-8.

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Moreover, are there some serious problems in Taiwan's medical system ―― hospitals and medical personnel (including medical doctors, nurses and hospital leaders) ?!

● Apple Daily (蘋果日報, 4-15-2019), United Daily (聯合報, 4-14-2019) ... : Going easy route, lacking of ethics, MDs advised/used Da Vinci for even a minor operation,  38 hospitals were suspected of making false report about Da Vinci surgery to illegally obtain benefits from national insurance up to NTD 3.5 billion.

● The Liberty Times, (9-29-2018) : Taipei mayor Ko: Taiwan's medical services all aim for profit, the problem of politics there is everyone tells right from wrong, but no one wants to do the right thing.   In Taiwan, the better medical knowledge, the less profit ― M.D.s curing patient of disease by simpler methods can not make good money, instead, they tried to convince you to do Hemodialysis, Positive airway pressure, ... or even to stay in intensive care unit (ICU) ...  LTN 11-27-'15: medical problem is political problem, the whole medical systems were manipulated by mega-corporation, and no one wants to make any change ...  The Liberty Times (LTN) 11-26-'15: Taipei mayor Ko said physicians or medical Doctors of Taiwan just don't speak the truth, otherwise they will be killed, or be accused...  Ko doesn't like to join even the most important meetings of National Taiwan University Hospital ( AIT of USA once called it the Jewel in the Crown) ―― in there, either "paper over the cracks" or taking chance to struggle each other.

● The China Times, (7-4-2017) : former leader of Taiwan University Hospital criticized that many hospitals' management is only for profit-making, hospital managers should win by virtue, physicians should advance their knowledge and tech. all the time, otherwise "patients centered" is nothing but a slogan.  

● Apple Daily, (8-18-2018): "The rich see Doctors, the poor enter grave ? (有錢看病、沒錢等死)"? / former medical gov. leader 楊志良。  Popular TV star 白冰冰 said (June 2017) : "The rich cut in a queue to see Doctors, the poor are on the way to die (有錢免排、無錢等埋)" !?   

● United Daily News (9-28-2018): <我們都是病友>: ... The administration and part of Taiwan's medical circle have not treated patients' rights as central issue (病人為中心)   / 楊志良。

●  Apple Daily, 12-30-2017: Amending the law of Taiwan's medical services is criticized as "Decriminalization".   Taiwan's medical-service environment is getting worse (台灣醫院免責? 醫療環境再惡化).  Patients in Taiwan will be difficult to put to the proof in their legal cases.

●  FTV 4-16-2017 : only 50- out of 1000+ NTUH physicians joined a protest (leader: NTU dean Lee (李鎮源)) for freedom of expression and human rights.  Reports pointed out Taiwanese physicians're afraid of speaking freely which may damages their future, since so many elites were killed in 228 political event, some victims got serious consequences for sort of minor mistakes, all these experiences and perspective deep rooted in some medical people's mind...... (some M.D.s and nurses or even the hospital functioned as state machine's barking dogs)  

● United Daily News (5-30-2017): The biggest problem of Taiwan's medical care is too short diagnostic time, without a completed examination in most cases, usually, patients are already in serious condition when symptom became clear. / Dr. Huang D.F., president of Dr. Sun Yat-Sen Cancer Center.
● Apple Daily (6-4-2017): Taiwan's critical problem ―― Preventive Health-Care service is behind. / former medical gov leader Young (楊志良).

● A famous M.D., Hsu or Xu Da-Fu (許達夫)'s book "Exposing the truth of modern medical circle in Taiwan - misdiagnosis & medical errors" ("誤診誤醫", published by the China Times, 2012) criticizes :
    (1) Taiwan's hospitals focus on profit/benefit and ignore patients' rights (in Ch.1 "Taiwan's medical system is ill")   ―   The whole medical circle already went the wrong route, it gonna be too late if most influential and enthusiastic persons do not spend efforts on completely changing our medical education to boot physicians' medical spirits.
    (2) Medical students only learn Pathology and the way how their professors doing malicious competition and internal struggle for the power and money, and lack of Ethics knowledge as well as Humanism quality.

●  Taipei City mayor Ko : Taiwan has not established a culture of honesty, each time being in National Taiwan University Hospital's meeting, the 1st thing crossing mind always is "who performed the operation (surgery) ?", M.D.s always take it personally ... ( '無法真正做到對事不對人')  /  buzzorange.com/2015/05/29 " The phony culture in Taipei City Hall - 整個社會都在說謊？！柯文哲揭露市府假面文化" http://www.chinatimes.com/realtimenews/20170611002397-260407

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★1.   serious Corruption - ready to pay a bribe?

According to <Transparency International> studies ( July 9, 2013), "Have you or anyone in your household paid a bribe to one of these 8 services in the last 12 months?"
 Taiwanese people think the institution needed to be paid bribery most is judiciary system, second is Taiwan's medical and health services, the number of Taiwanese paying a bribe is higher than global average. ( Apple Daily 7-10-2013,http://www.appledaily.com.tw/appledaily/article/headline/20130710/35139300/ )
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<Transparency International> of Germany also found the percentage(%) of Taiwanese respondents who felt medical and health services were one of corrupt/extremely corrupt institutions in this country/territory is 47%. 

The Liberty Times (1-10-2017): The hospital M.D. got brokerage or kickback in various forms -  e.g., money, presents/gifts, joining international seminar or conference sponsored by medicine business, or money that contributed to some foundations ... It's a complicated Symbiotic relationship (benefit each other).

PS

◆ Apple Daily (蘋果日報, 4-15-2019), United Daily (聯合報, 4-14-2019) ... : Going easy route, lacking of ethics,  38 hospitals were suspected of making false report about Da Vinci surgery to illegally obtain benefits from national insurance up to NTD 3.5 billion. 　 　 ◆ pic.: 東森電視; Global News TV - 寰宇綜合, 3-21-2018, 6:40 pm "醫師好辣" - "unspoken secrets in Taiwan's operation rooms":  Patients usually prefer the first operation in each day, this happened that 3 patients all paid bribery to the famous surgeons for having the 1st operation, and all of them had it ...... 　 　 　 pic.: Control Yuan (gov.) corrected National Taiwan University Hospital for a national insurance scam case / UDN, 2019 　 ◆ United Daily News  (聯合報), 7-12-2019: Control Yuan (gov.) corrects National Taiwan University Hospital's  (1) being long term neglectful in management,  controls  and taking precautions, or any measure to prevent this sort things from happening again,  (2) taking a passive, negative, idle-slowly attitude toward a national insurance scam (by NTUH physician),  (3) not checking carefully in a wider range of this issue,  since the suite case was under investigations,  NTUH expressed it's done by the MD himself and the hospital will review all related procedures. (brief, for precise meaning pls. see the pic. above) 　 ◆ The finding of the 2013 Global Corruption Barometer (GCB),  ( the Gallup Poll to interview 114,000 people in 107 countries all over the world): 36% of  people (surveyed in TW) who had used any of eight government services in the past year had paid a bribe (the number is higher than global average).    <NOWnews> , (7.10.2013)–  Taiwan is the 18th worst corruption country in 95 countries surveyed. (重度貪污國家第18名)  <Apple Daily> (7.11.2013): Apple daily's survey found 75.07% Taiwanese people think corruption in Taiwan is actually worse than GCB's report. 　 ◆ <Transparency International> , Taiwan,   Dec 9, '05      Taiwan's Corruption Index : medical 32%      ps: this proved Taiwanese medical service is a long lasting rotten circle. ◆  China Times, 11-21-2015 (brief)      National Health Insurance committee members think Taiwan's Admin. Department treat  National Health Insurance as their own gold-mine or pocket money - withdraw it as much as possible (成了自己的金庫 予取予求)

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★2.  worse Medicine

       The Next TV news of Taiwan (5-25-2019, 20:44 / 壹新聞  壹電視) reported that Taiwan government kept adjusting the price of more and more drugs to cover the deficit of medical insurance system, which resulted in more and more international brand drugs withdrawing from Taiwanese market (e.g., TIENAM) .   Behind the slogan "the price of medicines of Taiwan is cheapest in the world" is the cheap-price generic drugs made in Taiwan are not as curative effective as brand drugs, because Taiwan's drug companies don't insist on strict quality control on every process, and will not "tighten nerves" after having official permissions from the government.   Physicians worry there's no good medicines for patients ...  In April 2019, Taiwan government continued to adjust the price of 7470 items of medicines, furthermore, the hospitals kept haggling with the drug companies (e.g., the gov. declares certain drug NTD10, the hospitals cut it down to NTD 7 ), the price difference became main profit for the hospitals... ( brief )

       The Apple Daily (6-30-2018): Medicine (drug store) is a criminal business for their entire life.
       The Apple Daily (2-20-2016, Prime News): according to clinical experiences, many generic drugs are not as effective as brand drugs...
       TVBS news reported at 7-15-2015 that (http://news.tvbs.com.tw/life/news-608090/) in order to maximize the profit,  Taiwanese hospitals always cut down the price while purchasing medicines from pharmaceutical factories, this results in international brand drug companies are/were not willing to sell their brand-name medicines to Taiwan, therefore, the quality of prescription medicines in Taiwan is from bad to worse (用藥品質越來越差) .   Former Minister of Health (楊志良) criticized that Taiwanese hospitals do not like to improve medical employee's (M.D.s and nurses) welfare by using their surplus profit.   Many hospitals run their business by "medicine to cover medical" strategy, which is, earning profit by medicine price differences to cover hospital's expenses.   If things go on this way, Taiwanese patients will not have good brand-name medicines even being willing to pay on own dimes in the future, more and more international drug companies may pull back from Taiwan's market for unreasonable high medicine price disparities.  Apple Daily of Taiwan reported at 6-22-2015 that Taiwan's hospitals already used medicines made in Taiwan to replace int'l brand stuffs, and then, recently even don't like to buy some local's medicines (最近甚至連台廠藥都做不下去), till now, money can't buy some important antibiotic medicines.

        The United Daily (9-1-2015)'s article "medicine is cheaper than candy" (by 楊志良):  Almost all International pharmaceutical factories/companies had already withdrawn their business from Taiwan many years ago, Those companies having brand drugs within term of a patent show no interests in Taiwan's market,  This "Black Hole" resulted in "bad medicines/drugs drive out good"...

        The United Daily, the Apple Daily (9-3-2015, Prime News):  Taiwanese government's new policy - patients paying the part not covered by NHI use brand drugs, is criticized as creating a "class distinctions" (class antagonism), but some cases found generic drugs are not as effective as brand drugs, UDN also mentions medical government lacks of ability to admin. the bigger and bigger drugs/medical device market paid at patient's own expense...
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pic. above: Medical human rights in Taiwan	pic. above: one surgeon performs many operations simultaneously - happened quite often in Taiwan    Dr.Xu's  book   /  by The China Times

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★3.  Surgery

United Daily (聯合報, headline news, 5-11-2019):  unspoken secrets inside operation rooms: Many hospitals reused expensive expendables, some smaller hospitals reused cheap expendables, like medical gauze, suture, etc, the patients under general anesthesia knew nothing and hence were exposed the risk of infection.

Apple Daily (9-18-2017) reported that "fake surgery" (substitute-surgeon operates illegally) did happen in Chang Gung Mem. Hospital, Taiwan.

Apple Daily (5-13-2015) reported that Taiwanese people have an "Obsession" ―  famous is best, hence, an evil trend "one surgeon performs many operations simultaneously" (「跳台開刀」) prevails, which is a long-lasting cooperate module  ――  a best-known surgeon-physician walks and looks around several operating tables in different operation rooms (all are in his name), and selects a major one to perform a most important part of that surgical procedure, the rest are taken over by 'unknown or less famous' physicians.   (http://www.appledaily.com.tw/appledaily/article/headline/20150513/36547459/)

A famous M.D., Hsu or Xu Da-Fu (許達夫)'s book "Exposing the truth of modern medical circle in Taiwan - misdiagnosis & medical errors" ("誤診誤醫", published by the China Times, 2012) also criticized this by a real example, a patient complained : the substituted surgeon was not the one on the agreement document with patient's and his in-charge physician's signatures, that substituted doctor even did not know which part needed to be performed operation when he was there in the surgical suite, after the surgery, the patient's wound has become inflamed... Dr. Xu explained this sort of story indeed happened frequently (經常發生) in today's hospitals, particularly, in major hospitals, because each best-known medical doctor has many patients, it's hard for the doctor to take care of everyone, hence, substituted surgeons doing operations for best-known M.D.s is quite often (常見), particularly, for those famous physicians in charge also working as teachers, lots of things keep them very busy.   Dr. Xu suggested every patient must keeps in mind who is your M.D. in charge, and if you see a substituted doctor showing up in surgical suite, just refuse him to do the operation, unless you are in an emergent situation. 

● 東森電視; Global News TV - 寰宇綜合, 3-21-2018, 6:40 pm  <unspoken secrets in Taiwan's operation room> "醫師好辣 - 開刀房不告訴你的事", discussed the phenomenon ―  "one Doctor performs several operations at the same time", and  small Doctors perform operations for top Doctors without notifying patients 　 Full text : https://www.youtube.com/watch?v=gT2p7b4ZTQg
	pic. left: In medical centers or large hospitals, you may gave surgery by "students",  in small hospital, you may have operation by "master teachers" .
	pic. left: It's very possible that resident-Doctors (sometimes, or even CR  MD) replaced top MD to perform operations without notifying patients.
	pic. left: The larger hospitals, the more possible small MDs do operations for top MDs .
	pic. left: even in training-purpose cases,  quite many "teacher" MDs still leave operation suites.
	pic. left: It was this way years ago, security guards did operation, MDs became their "assistant".
● 蘋果日報 ◆ Apple Daily (5-13-2015) reported that a famous physician (ranking top 100 in Business Weekly) in Taiwan's Taichung Veterans General Hospital performed 5 operations at same time, that caused a woman's death and his new  name - suspicious crime of fraud. (http://www.appledaily.com.tw/appledaily/article/headline/20150513/36547449/) (中榮名醫同時五台刀 涉詐欺  害婦送命 疑沒進開刀房也領獎金 /  廉政署鴨子划水蒐證數月後，發現《商業周刊》百大良醫沈男 兩年內疑有十件跳台開刀情況)

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★ 4. Bad privacy status in Taiwan's hospitals
      ◆ The China Times, 7-3-2017: Taiwan's regulations for patients' privacy is almost no legal effect, hospitals don't take it serious.  e.g., a 30 years old female patient was hospitalized in a very famous hospital 榮總, after she striped her clothes for MD's diagnosis, more than 10 male and female physicians came in, one student (probably intern) took picture by cell phone, the patient can't stand all these and burst out crying .....
     ◆ The United Daily News (聯合新聞) 1-3-2017 <Where's Taiwan's medical ethics ?>  : Leaking patients' medical records is a normal social behaviour in Taiwan - In Taiwan, journalists are not used to respect patients' privacy... our hospitals' members do not know very clearly the principle of protecting patients' privacy...(黃達夫)
       ◆ Apple Daily (3-5-2017): A large hospital's nurse took a picture of the patient without any permission during brain operation in surgical suite and then spread that photo through Instagram.  That nurse also remarked "It's so exciting to see human's brain!".

              

	pic.: The United Daily News (聯合新聞) 1-3-2017 <Where's Taiwan's medical ethics ?>

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★ 5.  No.1 hospital in Taiwan
      FTV(民視) <Taiwan History(台灣演義)> 4-16-2017 , "Taiwan University Medical School"  (for details pls ref to youtube https://www.youtube.com/playlist?list=PLf2VRok0uRO2bH10tnVg9rWCIGeddXcSk)

★

★ 6.   Ethics, Ethics,  Ethics

       According to the book, < Disease and society ― Taiwan searches its conscience from experiences during SARS crisis>  (book title : <疫病與社會：台灣歷經SARS風暴之醫學與人文反省 >, author/ 蔡甫昌、江宜樺(former Prime Minster)etc,  Publisher/ National Taiwan University, Medical School,  Sept. 2012 )

     ◆   Many medical school students' parents scared SARS and ignored the situation that insufficient numbers of doctors confronting SARS,  hence, those parents pressed the government to pull 300 intern students out of hospital by reporting "something" to the Control Yuan that Educational government already neglected its duty.
       ◆  Some state hospital paused emergency and regular medical services (門診), about 1/3 clinics there stopped their services by all kinds of "reasons" you can imagine.  124 nurses in a medical center in Southern Taiwan refused to take care of SARS patients and then resigned, some M.D.s also resigned for the same reason.
       ◆  Some medical center found hospital infection and  took "block & isolate " strategy, the next day more and more patients at ward escaped from that hospital, Taiwanese government received reports from all major medical centers in Northern, Central, Southern Taiwan, the hospital president,  and Infection Control directors concealed SARS outbreak within the hospital to avoid losing face, avoid dropping profit-performance, and/or avoid being sealed off the hospital,  this serious situations became major cause that Taiwan's SARS continued to spread larger and larger.     
       ◆  The work ethics, concealing SARS outbreak, delaying reporting to center government or rejecting SARS patients to avoid profiting worse are the most important reasons resulting in hospital onset of infection and spreading SARS from bad to worse in Taiwan. 

◆  Taiwanese personality/character, pls click for details... No.1 ranking on google for a long time!

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★ 7.   Nurse  Taiwan Hospitals' illegal situation was or is serious (醫院違法的問題非常嚴重)  

         ◆   Fake nurses/patients ratio.  The Evaluation of The Effectiveness of The Hospitals by government can not find something like nurse working in the name of  technician, nurse-license was used for fake statistics...

        details pls. ref. to Taiwan enrolled nurses general union (護理工會) and Taiwan Labour Front (台灣勞工陣線) web-site http://labor.ngo.tw/news/news-now/189-news20150511  or Liberty Times  http://news.ltn.com.tw/news/life/breakingnews/1313447
        ◆   The capital (management) side completely controls unreasonable payments,  in spite of that the government reiterated on-call time should be count for working hours, but investigation this time found 96% nurses' on-call time has not included in their wages, Taiwan's hospitals seriously violated the law.  (違法的問題非常嚴重。)
        ◆  Next TV (壹電視/正晶限時批) at 9-27-2015:  The ratio of nurses and patients in Taiwan's hospitals is absurd. (都太離譜了)
        ◆  <The China Times > (1-12-2016): Taipei City found all hospitals it check violated the labor law.  
        ◆  <The Liberty Times>, <The China Times >, <The United Daily> at 12-30-2015: 87% of Taiwan's large hospitals had surplus in their balance sheet of 2015, but staff/labor costs decreased from 45.86% downto 40.06%, medical staffs are still in a "Sweat factory" status, hospitals used their surplus on "arms race" -  aesthetic medicine, Proton Therapy, Heavy particle therapy, high-end medical check, The da Vinci sys., etc. to attract people to pay on their own dimes so that hospitals will have more surplus, besides, medical resources concentrate on metro large hospitals, it's unfair to remote countryside patients, in the future, it is expected to exhibit a polarizing outcome ― middle and smaller sized hospitals likely will closed, only small clinics and metro hospitals left or survived.

ps:  TW  amended the law http://www.chinatimes.com/newspapers/20170407000409-260114

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◆  ◆  pic. above:  strykers (wheel-beds) are everywhere in long and narrow corridors/walkways of NTUH, just like a "combat hospital". ◆ pic. below: National Taiwan Univ. Hospital's board: The waiting time for a ward might up to 10 days... pls try other hospitals ! ◆  pic. below right: treatment in emergency room taking more than 48 hours - top 5 rankings / source: TW gov. ◆
ps: FTV news (2-27-2019) reported that patients usually take 5~7 days or even nearly half month in emergency room of NTUH awaiting being hospitalized.

★ 8.  Abuse or use too little medical resources

       
        <Liberty Times>, 8-19-2019, headline news:  "CT scan, MRI were used for mild cases - getting cold or sore throat",  Taiwan government corrects hospitals using CT and MRI in the number 130 thousands for mild cases, the "abusing" rate of 92 hospitals is too high.
        <Ettoday>, 8-19-2019: In 2017, one person did CT scan 24 times in a single year.
        <United Daily News> (12-31-2013) by president of Dr. Sun Yat-Sen Cancer Center : after a surgical operation, a woman cried piteously 8 hours for belly pain and then died, there's no any medical doctor came to take a look at her even her families look for help 9 times before her death...  For saving some money, some hospital admitted using recycle-bag for tube-feeding ... 
          <Apple Daily> of Taiwan ( 6-22-2015 ) points out in some cases acesodyne (painkiller止痛藥) is not allowed to be given for some terminally ill cancer patients in Hospice-palliative care after his having signed a give-up-emergency-treatment agreement.  It's wrong that hospitals think money higher than humanity.

       <The Liberty Times> reported at 5-26-2015 that Taipei mayor Ko expressed Taiwan's hospitals abused ECMO (extracorporeal membrane oxygenation), taking National Taiwan University Hospital as example, till now ECMO has been used for 1800 times, 10% of them won't save those patients' life - from the first place they should know.
         <Exposing the truth of modern medical circle in Taiwan>: Taiwan's M.D.s are accustomed to give patients lots of prescription medicine more than needed.

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★ 9.  lots of FAKE medical records

         <United Daily News> (12-31-2013,  <台灣醫安問題 須誠實面對> >) article <Facing Taiwan's medical safety issue> by Dr. Huang D.F., president of Dr. Sun Yat-Sen Cancer Center : In addition to those fakes created by Taiwanese government and enterprises, one more "fake" has been hidden in extreme dark side - that's Taiwan's medical record.  The patient's record usually is used for medical studies and NHI benefit package, it look OK in form, but the quality is from bad to worse.  Taiwanese government usually see only with one eye on or turn a blind eye to fake or cheating things as long as you have contribution to Taiwan's GDP...

        <United Daily News> (12-11-2013,  <台灣假的病歷 誰來監督?> (章貢):) : Fake medical records of patients include - 1. made by copy & paste way,  2. evading the crucial part &  lacking of clinical symptom, 3. irrelevant or not speaking in details, 4. creating something from nothing (so patients will be in bad situation for any legal case in the future), 5. substituting on for another (by unqualified staffs), 6. add/delete/modify something - for evaluation, investigation or legal problems. (1.蕭規曹隨、複製貼上式 2. 避重就輕、缺乏臨床症狀 3. 牛頭馬嘴、語焉不詳  4. 無中生有、讓病人處法律劣勢 5. 移花接木式(由尚未立法的護理師等，甚至什也不是的記錄員處理拼湊 )  6. 塗改增修式 - 遇評鑑、抽審、或法律糾紛時如此處理 ......)

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★ 10.  completely FAKE evaluations by the government

       ◆ Apple Daily (6-2-2015, "完全造假的醫院評鑑" by 呂享諧M.D. http://www.appledaily.com.tw/realtimenews/article/new/20150602/621194/):  The fake evaluations of the hospitals by government were done by officials and hospitals, those "mutual understand" fake items include hospitals employing ghost nurses and temporary nurses who will be fired after the evaluation, fake SOP, fake meeting records ...  the evaluation results - different level of hospitals, may affect up to 10 billion + dollars annual income by hospitals.

        ◆ Next TV (壹電視/正晶限時批) at 9-27-2015: 6 false shows in the evaluation of Taiwan's hospitals

           False evaluations are everywhere in Taiwan, from army, fire-extinguish dept., to many other businesses... including hospitals.  Since Taiwan's government informs the time for evaluation, hospitals have plenty of time to plan everything in details for a false results.

           1.  In evaluation day, hospitals request rookies to take a day off or specially arrange evaluation-committee members going specific route, in there they only meet senior medical staffs.
           2.  Hiring people for short term or taking administration staff into statistics make a beautiful ratio of nurse and patients.
           3.  For dealing with evaluation, hospitals limit the number of outpatients, decrease  the number of inpatients, and patients in emergency room waiting for a inpatient-bed.
           4.  Medical doctors and nurses are busy in paper works for evaluation, decreasing the time to take care of patients.
           5.  Hospitals are busy for evaluation or authentication, so as to create a false image of perfect administration and high degree of medical skill.
           6.  In evaluation day, hospitals request all medical staffs give evaluation-committee members "model standard answers" (『標準答案』).

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★11.   shady & shabby deals in medical circles -

   ●  money  brief from Broadcasting Corporation of China (BCC) exclusive interview former minister of Health, Dr, Yang C. L., rpt. of 2011/04/14 United Daily News (聯合新聞網), and 2011/04/18 The China Times (中國時報)  

              ◆  pharmaceutical factories and opticians tried every efforts in offering all kinds of attentive services to target physicians, paying check for their going abroad and meal is just "basics",  "extras" are, e.g., taking the initiative to sponsor a certain foundation, arranging local entertainment girls together with them during a medical conference in mainland China, etc.  Some physicians even have a "wife" in each province of China.

            ◆   He was told certain price is needed for some top positions like provincial hospital president or assistant administrator.

           ◆   The  Liberty Times (8-28-2013) : according to latest report by dept. of labor, 6 out of 21 sweatshop hospitals are state hospitals, their illegal deeds include giving no overtime payments for overtime workers, etc.

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       ●  politics

         ◆   Hospital's long-standing malady that Dr. Yang (楊志良) exposed is just the tip of the iceberg, ugly dark sides of Shiroi Kyotō (Taiwan's hospital and medical doctors) and pharmaceutical factories are inseparable, closely linked.  Pharmaceutical factories focus on public hospitals joint purchasing projects (聯合採購標案), major battle fields are 退輔標、軍聯標、署聯標、市聯標,  hospital's president actually is the key man in the shadow, although avoiding purchasing things on the surface.  Besides, political connections help, hospitals usually buy politicians, say, legislator's letter. 

             ◆    Next TV (壹電視/正晶限時批) at 9-27-2015:  "Terrible white terror in Taiwan medical services"
                    1. "Auditing & expense/budget controlling" becomes inspection-committee members' means for revenge (核刪成為審查委員報復手段)
                    2. The reasons for cut off some expenses is groundless, leading to patients missing best time for curing. ( 核刪理由"莫須有"錯失治療黃金時間) 
                    3. In order to push patients to pay on their own dimes,  inspection-committee members not only cancel some expenses, but also double deduct it (倒扣).
                    4. Encouraging using drugs/medicines made in Taiwan, influencing medical doctors' judgement and decision.
                    5. Taiwan government may blames  inspection-committee members sometimes cut off some expenses without good reasons, but, actually, committee members just followed the government's "hint" to do it.

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            ◆   I personal encountered some suspected cases concerning collusion between medical staffs and politics ...

★12.  clinic's  out-patients   VS.  hospitalized patients

                        ●  " In Taiwan's health-care systems, senior attending physicians or top MDs treat out-patients in mild condition， junior (or rookie) Resident Doctors treat hospitalized patients in serious condition， that's put the cart before the horse  ! ".   Taipei mayor Ko criticized。

       ●   Most patients needed to be hospitalized are the elderly with multiple diseases for years , however,  Taiwanese Medical Doctors in various divisions specialize in one field only， and only like to pick up one-disease patients。  Hence, some patients stayed in emergency room for 28+ days and then left or just died on the wheel-bed 。  /  for details pls. read <天下雜誌> no. 498 (2012-05-29 )  , intro. to mayor Ko & ntuh 7d's new try, following "Hospital Medicine" system's footsteps,  around 2012, about 20-50% hospitalized patients were taken care by the hospitalists, in the US.     https://www.cw.com.tw/article/article.action?id=5033140
                        ●   In my experiences in a few hospitals, sometimes you may have clinic MDs or senior/top physicians, but most of time they are quite busy .....  

★

★

★13.   Discriminations in Taiwanese hospitals

        ●  Taiwan Television Enterprise (TTV) Commonhealth Magazine (康健雜誌, issue No.184)  <Some specific patients bear the stamp of suffering >:  Some patients go to hospitals out-of-town, or even go to several clinics each in different hospital ――  what's patients' secret behind ?  the answer is , e.g., some Melancholia (depressive disorder) patients do it this way, another case is when some physician found his patient is Psychiatry patient as well, he showed impatient and pushed his patient to go consulting Psychiatry M.D.,  so that this patient feel himself a sub-patient in medical service。 (brief,  author：吳佳璇)
                ● Taiwan University Hospital , "The jewel in the crown of health care providers",  is suspicious of discriminating elderly people (or all people) living alone in medical examination - stress-free anesthesia colonoscopy,  NTUH staffs seem not welcome this group of people, who are not allowed to do this examination alone, or even accompanying by another old people or a young household caregivers who is specialized at taking care the elderly.  NTUH does not allow the examinee to do anesthesia colonoscopy unless a younger family member coming together.    This unreasonable condition is not written in the signatured agreement, and never let examinee know in advance, furthermore, it's ruled by men, not a 'institutionalization', which means some cases are fine, some others may not be permitted.  (ps: On Dec. 2016, NTUH added "Together with a family member or a friend is a must for examinee to do anesthesia colonoscopy " on the agreement)   ps: FTV HD 民視台灣台 , <新聞大解讀> , 3-1-2018  8:52pm: Taiwan will enter a "zero families age"("零家屬時代").

★

★14.   only 3 min. for each patient

       The United Daily News (聯合新聞) 1-3-2017 : How can those M.D.s spent 2 minutes on those patients with complicated or serious condition... Fast medical diagnosis (100+ patients per clinic) may increase the probability of  incorrect judgments...  (黃達夫)

        Dr. Ye Ching-chuan (former leader of health government, 葉金川) blog (6-30-2009): Taiwanese go to clinics 15 times per year, 3 minutes with M.D. each time, in contrast,  Americans  go to clinics 4 times per year, 15 minutes each time；TTV(台視常春, 3-1-2011): Taiwanese patients talk with M.D. for 3 minutes only (看診3分鐘，該跟醫生說甚麼...)；CTS(華視, 5-19-2010): A popular M.D. in Kaohsiung spent 1.4 minutes in average on each patient...

★

★15.  Half failed to pass health inspection

     The Liberty Times (11-29-2016): Half of random-selected hospitals failed to pass  (Food and Beverage Sanitation  or environmental Sanitation ) health inspection.

★16.  all of us are unwanted clients

     ●  United Daily,   2-3-2018,    https://udn.com/news/story/11319/2966710
               Taiwan's hospitals have an unspoken rule ―  inpatients staying in ward more than 28 days might be "forced" to be discharged from hospital, many turn into "unwelcome tramp" wandering from one hospital to another, although there's no this kind of laws or regulation made by the government.   Most of these sad people are stroke patients.

     ● <China Times Weekly> (8-28-2015 ~ 9-3-2015, No.1958) article "The crisis of Taiwan's Medical & Health services" (by Taipei City Hospital leader /黃勝堅) : "When medical solutions become too commercialized, and lose humanistic care and respect, sooner or later, Taiwan's medical systems will face a  severe challenge of breaking down..."。

      ●  impact of DRGs (new version of insurance) ― negatively affect patients in Taiwan as below:

      ◆  Patients with multi diseases may become unwanted clients (medical negligence, Chinese namely "人球") - hospitals may filter patients, reject some or deal with their disease only one at one time -  hence patients waste lots of time for it..

      ◆  The number of items to be paid at patient's own expense increases if you want same quality of treatment as before or a complete & precise medical examination.

      ◆  Patients may be asked to discharge earlier even they have not healed or recovered completely, if you 'd like to be in ward for more days, pay on your own dimes, because DRGs push hospitals to discharge patients 3~5 days after treatments or operation, otherwise the hospital will absorb additional cost ― which means losing money. 

      ◆  Do those examinations only for the item why the patient is hospitalized at this time.  

      ◆  If a patient needs 2 surgeries, hospital will find some "reasons" to push the patient leave hospital after his/her 1st operation, then the patient pays extra efforts to be in hospital again for his 2nd operation. 

      ◆  If a M.D. 's patients' amounts of medical expense covered by insurance are over the budget's upper limit, this MD physician's "performance" (績效) will be reviewed or examined by his hospital.

      Details pls. ref. to <今周刊>(Business Today) 10-31-2014

★17. Fake medicine
     Apple Daily 2-24-2017, 3-7-2017 :  Crestor (a most popular blood-lipid lowering drug by AstraZeneca), ranking No.1 sales-amount covered by Health Insurance in 2016, was faked by illegal Syndicate.    Since the circumstance is from bad to worse, the government declared to retrieve all Crestor.
       The Liberty Times , 3-15-2017 : The leader of National Health Insurance stated medical people pointed out faking drug is because the price of  brand or regular medicines was cut down to bottom...  they choose to fake the most popular drug if have to be illegal...

★

★18.  sexual harassment in hospitals

         The Apple Daily 7-17-2019: A MD of Tri-service General Hospital is suspected of lifting a female patient's clothe and poking her breast in a private room without any female nurse there.

         The China Times <中國時報> 3-8-2018: according to investigation/survey, 80% female physicians met sexual harassment, ... a female physician of Cathy Hospital had different views and said the percentage of harassment to nurse probably higher because they are young and in lower status  (8成女醫曾遭性騷擾, 女醫反應兩極 ... brief)

★

This sites were among top ranks by Chinese keywords "comment Taiwan hospitals" as well as "comment Taiwanese MD"  on US Bing, Yahoo, US Google, etc
pic. above: No.1 by Chinese keyword  "comment Taiwan hospitals" on US Bing, tests at 2-9-2018	pic. above: No.1 by Chinese keyword  "comment Taiwan hospitals" on US google, 2-6-2018,  4-19-2017,  1-22-2017, 6-11-2016, 2-21-2016
pic. above: No. 2 by keyword  "comment Taiwan hospitals" in Chinese on US Yahoo, at 2-9-2018. 　 　                   pic. left : No. 1 by keyword  "comment Taiwan hospitals" in Chinese on US Google, at 2-18-2018.   pic. right : No. 1 by keyword  "comment Taiwan physicians" in Chinese on Google Taiwan, at 2-18-2018. 　 　 　                      pic. left : No. 1 by keyword  "comment Taiwanese physicians " in Chinese on Yahoo Taiwan, at 2-18-2018.   pic. right : No. 1 by keyword  "comment MD in Taiwan " in Chinese on US Bing, at 2-18-2018. 　 　 　 pic. above: This websites group's ranked No.1 on Baidu of China by keyword "medical doctors in Taiwan"  at  2-6-2018.

★

★ 19. Court Doctors

       Apple Daily, 4-27-2018:  Taiwan got only 3 court Doctors / legal medical experts can do operations.  

★

★ 20.  inspection failure - hospital & long-term care problems
       United Daily, 8-14-2018:  Taipei Hospital big fire, in recent 6 years, 5 fires, 36 died, 185 wounded in nursing home (long term care facilities).

            Apple Daily, 8-14-2018:  6 fires in 7 years.

★ 21.  The quality of air in hospitals  /  best hospitals like NTUH failed to pass bacterial concentration tests

★ 22.  MDs and patients taped each other secretly for self-protection

https://www.youtube.com/watch?v=7Af-XbYICxI   TVBS 7-12-2015  & 5-25-2015

https://news.tvbs.com.tw/life/581627

https://news.ebc.net.tw/news.php?nid=73470

https://www.cw.com.tw/article/article.action?id=5076858

★ 23.  Major medical malpractices happened again and again

        ◆  <United Daily>,  (11-18-2018): Major medical malpractices and patient safety events happened again and again, medical reform group suggested legislating a new law.

        ◆  <The China Times> (11-17-2018) : Ridiculous mistakes !  Tzu-Chi Hospital's nurse took injection of urine (as Normal-Saline) mixed with albumin to a patient, 10+ days later, that Cirrhosis patient died.
       ◆  <The China Times> (6-24-2018) : A nurse of NTUH connected wrong Hemodialysis pipeline (tap running water replaced bacteria-free medical water) to patients doing kidney dialysis in ICU (Intensive Care Unit) resulting in 1 weak died a few days later, and several may be affected.    Dirty water into blood vessels may caused Sepsis, NTUH accepted too many patients and lacked S.O.P. for risk management.   <Liberty times>, 7-6-2018, <Apple Daily>, 7-7-2018:  Chinese Medical University Hospital had similar mistake at 2-23-2018, one patient was affected, National CK Univ. Hospital at 5-24-2018 misused bleach to do kidney dialysis, fortunately, the machine was shut down for abnormal detective signal,  National Taiwan University Hospital at May 25 & 26, 2018 affected 6 patients, 2 patients died, not caused by this, based on initially judgment.

       ◆  <Apple Daily>, 11-18-2018: Mackay Medical Hospital (新竹馬偕醫院) gave wrong vaccine to 4 newly born babies in Feb. 2018.   Tri-Service General Hospital (三總內湖院) connected wrong intravenous equipment (pipe) to a patient in Feb. 2014.

★ 24.  Expensive instrumentation

Taiwan's hospitals invested huge money on expensive instrumentations, e.g., Proton Therapy (質子治療), heavy particle therapy (重粒子治療), Da Vinci surgery, etc, but their curative effects still can not be proven yet, or some of them are only good for some rare diseases, children's cancers.  Traditional Photon therapy is better for most cancer diseases.  Expensive instrumentations have not risen the survival rate of many cancers.   ref. to UDN, 7-1-2019 https://health.udn.com/health/story/7397/3901682

https://wd.vghtpe.gov.tw/Cancer_Cen/Fpage.action?muid=1652&fid=1244

★ 25. personal data

    ◆  <United Daily>,  editorial (3-31-2019):  Taiwan plans to sell general public's personal data and digital human rights (e.g., people's medical health data without giving any notice ) ... Taiwan is a less developed country on personal-data protection  (brief https://udn.com/news/story/7338/3728815)

★28.   Taiwanese M.D. crime rate global No. 1

             ●   TVBS 2012/07/27:  Taiwanese M.D. were accused easily and frequently, hence "crime rate" is world No.1  ---    In average, one Medical Doctor was accused per day, one was convicted per month.

     ●  Commonwealth Publishing Group (遠見) magazine, ettoday.net/news  2012/07/11:  The conviction rate (preliminary trial , district court judgment) of Taiwanese physicians is 24.5％.

★ 29.  male nurses  VS. female dignity

       ●   "Male nurses and the protection of female dignity" (NCBI, Dec. 2010),   "Male nurses attending to female patients (nudity) is 'morals vs. ethics'", etc, are issues in the US, certainly, should be a hot issue in Taiwan, a more conservative country.   In NTUH (2019), some wards are nice to arrange same gender patients in one room, in principle, but, some  NTUH ward was inflexible at all, they didn't care female patient's objections, still assigned male nurses ( the number is extremely small compared to huge number of female nurses ) to female patient, in most cases the number of male patients suppose is about the same as that of female patients.   TTV (台視), 10-29-2012 "尿失禁怎麼辦": even aged people may be very shy - refuse other people to see their private part ...   

★ 30.  health insurance benefits   VS.  health

         ●    When a patient denied a whole body CT scan suggested by the physician because of the risk of contrast medium, then the MD denied the patient's alternative suggestion - abdomen & pelvic cavity ultrasound and chest CT scan without contrast, even the patient was willing to pay the costs, this NTUH MD's reason is the hospital applying for National Health Insurance benefits might be denied by the gov.   However, another ward's MD (Chest Hsu) of NTUH is much flexible and nice - the patient can do MRI without contrast (July, 2019) to find out the problem.  So, hope you are lucky.

★ 31. case study - NTUH

     5-31-2019 ~ 6-5-2019,  NTUH, Taipei

           in NTUH ward,  the nurse gave anus turanda to the patient whose bowel has not moved for 1.5~2 days, but, in Observation area of emergency room, NTUH, the nurse ignored or forgot  the patient whose bowel has not moved for 5 days. 

     5-18-2019 ~  5-30-2019

    One of my families went to emergency room, NTUH (National Taiwan Univ.  Hospital ) for fever, weak, and susp. aspiration pneumonia.    I was impressed :
    (1) M.D. Fan-Chi Chang gave right treatment to improve patient's health status, and she was independent in changing Taiwan's leading Cardiologist's prescription.  Her senior nurse gave useful advice.
    (2) Police Station in NTUH and 仁愛 Rd. helped me to watch play-back of monitoring video for finding out who stole my belongings. 

2-5-2018 (about 10 : 30 am) , one of my families went to NTUH (National Taiwan Univ.  Hospital ) for CVA emergent treatments.

     (1)  119 ambulance and emergency technicians (from SongJiang fire brigade)  - excellent, fast and quick.   
     (2)  NTUH emergency room -  CR MDs are quick to see the patient, they did some check-ups (heart, etc), basic diagnosis and followed SOP - did not give patient rtpa because there's no proof that it's still within 3 hours since stroke probably happened.
     (3)  NTUH emergency room -  CT scan in afternoon, MRI at about 8 pm.

     (4)  NTUH emergency room -  nurses did some examinations, e.g., drawing blood for tests,  some pretty good, some pretty bad.

     (5)  All wards are occupied, the patient was in a medical mobile bed in hospital's aisle, like many others.   According to experiences, many may wait in cold aisles or even at very freezing gate room for more than one or a couple days ......

     (6) Care-givers - not difficult to hire one because many related business agents look around in emergency room  to provide care givers ( NT 2200-1600 for 24 hrs cares), although the number of hospital-contract care givers are not enough for demands.   ( In contrast, gov. long-term care system is much worse, some may wait a couple of months for none or no-good care givers )

     (7)  patient thinking, speaking normally.

2-6-2018

      (1)  Be hospitalized at noon, in a 3-beds ward. 

      (2) CR MD and attending MD well explained all about ... blockage of the brain artery causes ischemic stroke (CVA), it's a "小中風".    MRI shows other part of the brain may be risky, the main mission is to avoid new CVA happening.   The blockage will be there ... Recovery is not too easy because the patient is aged 94-95.

  2-7-2018

      (2)  a MD or physical therapist from Rehabilitation Dept. tests the patient - walking seems back, but still slant to the right more or less.
      (3)  attending MD look over, after treatments, the symptoms of breathing, swallowing problems improved. 

  2-8-2018

       attending MD, physical therapist, nutritionist came, CR MD came twice.  Patient had chest X rate and heart echo.
       Feb. 9  (Fri.), MD declared she is OK, and can be discharged from hospital next Mon. to avoid being infected.
       Feb. 10,11, 2018  care-giver helps physiotherapy, patient under observation...

  2-13-2018  patient is OK, and is discharged from hospital.   CR  MD got excellent attitude, and believed it's reasonable to use anti-virus alcohol spray in the ward to protect very old weak patients.

◆   To Be Continued ...

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