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NATMA 2G 回 Taiwan 2023

Updated: Jul 14, 2023

July 3, 2023 morning: Ministry of Health & Welfare 衛生福利部, National Health Insurance Bureau 健康保險署

Cheryl Wu, MD

We woke up nice and early to an AMAZING breakfast buffet at the hotel, replete with 燒餅油條 shao bing and fried cruellers, rice soup, myriad dim sum delicacies (芋頭包,shumai, etc), an omelette station, a noodle station, about 6 different kinds of juice (watermelon, soy etc), and a soba noodle station.

We got on the bus at 7:30am, and made a round of introductions as we headed off to the Taiwan CDC for an 8:30am conversation about the Taiwanese response to the Covid-19 pandemic. On the bus, there were 13 second generation physicians and dentists, along with 5 first generational 精英 NATMA officers. We hail from California, New York, Georgia, Kansas, and Wisconsin, and work in such specialties as Internal Medicine, GI, Urology, PM&R, Cardiology, Anesthesia, Neurology, Orthodontia, Pediatric Dentistry, Pharmacy, Dermatology, Urology, and Pediatrics.

We got to the CDC and promptly walked into a large conference room with wide screen TVs, and a panel of physician-officers of the 衛福部Ministry of Health & Welfare, a subdivision of the CDC.

We sat down with the director of the Ministry, who gave a brief description of three chronological phases of Covid-19 response on our beloved island, Taiwan. He described 253 days of "Covid Zero" that lasted from the end of 2019 to late 2020, as Taiwan switched gears to containment of small community outbreaks, as well as the inception of vaccination efforts in Taiwan in early 2021. However, due to an unfortunate black box warning of the Astra-Zeneca vaccine, Taiwan also saw some initial vaccine hesitancy. Finally, the director described the third Covid response phase, "Living with Covid", which started around 2022. The director, Dr 羅一鈞, Luo Yijun joked, we had to do a good job, otherwise we get yelled at by the Taiwanese people when we go grocery shopping 我們出去買菜還被台灣人罵. Spontaneous public grievance airing notwithstanding, I was struck by the exact combination of political art and medical science in order to effectively communicate with the public about Covid, the intricately choreographed cooperation between all levels of the government and its people, as well as how similar the issues Taiwan faced are to the US (misinformation, vaccine hesitancy, supply chain issues) when combating Covid. I couldn't help but compare the three phases Taiwan went through with the Covid response in NYC, where I reside, and the astronomical deaths we faced daily during the most heightened and acute phase of the pandemic (roughly 300 per DAY), in 2020.

After the Taiwan CDC, we boarded the bus and went across town to the 健保署 National Health Insurance Administration. This was very fitting to my area of interest, as in my line of work (pediatrics in underserved communities, ie, high percentage Medicaid recipients), I was often a front-line witness to how our broken insurance system severely impacts access to healthcare for the most vulnerable and forgotten portion of the American populace, children. To our pleasant surprise, there were name tags at every seat, along with hot tea and the famous 鳳梨酥 pineapple cake.

The director of the 健保署, Dr 石崇良 Shih Chung-Liang, gave us a beautiful talk about the one payor system 健保, which was established after the passage of the National Health Insurance Act in 1994. He highlighted many significant social determinants of health, as well as the vulnerable populations such as the elderly, those with chronic diseases, and the indigenous population of Taiwan. And in spite of the pandemic, the Taiwanese satisfaction rate with 健保 is at an all time high of 92.3%. Dr Shih also walked us through the most pressing concerns facing the Taiwanese populace, following the footsteps of neighboring Japan. The growth of the "super elderly" 高齡者 will outpace the growth of working age population within the next 7-10 years.

Unfortunately, due to the one payor system, the lack of PCP-referral system (so patients can see any subspecialists when they want to), 40% of Taiwanese physicians are not satisfied with the medical system as is.

After this incredible morning, we drove over to 台大, National Taiwan University, for an afternoon full of panels and conferences.

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