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)

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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), but 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, 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.pdf

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

● 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.
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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).

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 ★2.  worse Medicine

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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★5.  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. 

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★6.   Nurse  Taiwan Hospitals' illegal situation 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.

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★7.  Abuse or too-little-use medical resources

        <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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★8.  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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★9.  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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★10.   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.

       ●  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 politics collusion with medical staffs or hospitals ...

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★11.   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％.

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★12.   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)

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★13.   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...
          

★14.  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.

★15.  Leaking patients' medical records is a normal social behaviour in Taiwan
      The United Daily News (聯合新聞) 1-3-2017 <Where's Taiwan's medical ethics ?>  : 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!".

★16. 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.

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             ◆   To Be Continued ...

For precise meaning pls. ref. to Taiwan's medical and health service in Chinese version

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