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Former Health Minister Yang Chih-liang:

Keeping Taiwanese Doctors in Taiwan


Keeping Taiwanese Doctors in Taiwan


The migration of medical personnel is a global problem, and Taiwan is not immune. Can medical parks be the solution to Taiwan's health professional brain drain?



Keeping Taiwanese Doctors in Taiwan

By Whitney Huang
From CommonWealth Magazine (vol. 528 )

Taiwan's government must be wary of Chinese-financed hospitals dangling high salaries to poach Taiwanese medical professionals following the signing of the Cross-Strait Trade in Services Agreement (TISA), former health minister Yang Chih-liang has been telling local media.

What's troubling the former minister? Does he have a solution?

Following are highlights from a CommonWealth Magazine interview with Yang Chih-liang:

During the 1970s, Taiwan suffered a serious exodus of medical professionals. At the time the U.S. had a shortage of doctors, and around 80 percent of National Taiwan University med school graduates – the best and brightest – headed to the States. There was an extreme shortage of doctors in Taiwan at the time.

It's a common phenomenon throughout the world. The World Health Organization is deeply concerned about this form of brain drain. It has published reports documenting how the developed world is siphoning off the best medical professionals from the developing world. This is very unethical.

This is a lesson of history. The point today is how do we go about getting the many fine doctors we train to stay here in Taiwan.

The spate of recent cases of senior doctors packing up and moving to China to pursue their careers is troubling. The salary gap between Taiwan and China has continued to narrow, and that goes for all industries.

At some of China's top-tier hospitals, some doctors are already better compensated than their peers at Taiwan's medical centers; a lot are making 300,000 to 500,000 renminbi per month, including under-the-table income.

Taiwanese professionals have already set up dental and optometry clinics in Beijing and Shanghai. Their numbers are not yet great, but you can't wait until everyone is gone before you act. By then it's already too late. Watching the cross-strait income gap shrink, we should remain vigilant. An ounce of prevention is worth a pound of cure, no?

China has been going all out recently to expand its medical system, and Taiwanese medical professionals have a big niche there. If we don't start providing our medical professionals better opportunities for development here in Taiwan today, then we will surely lose a good number of them to China in 10 years time.

If Taiwan is to have a better opportunity, the government must establish international medical parks, allowing patients from China to seek treatment here.

The Most Employee-Intensive Industry

It should be understood that half of the expenses in medical service provision are personnel costs. It's a business of people serving people, unlike manufacturing. If you invest NT$100 billion in semiconductors or flat-screen panels, you don't need that many people to work a plant. But in health care, each bed requires an average of three medical staff. It's the most employee-intensive industry.

It's a shame that such high-end professionals are moving overseas. If they could stay in Taiwan creating productive value here, why should we let them go to China? Wages in Taiwan as a percentage of gross domestic product have declined from their original level of 50-plus percent to the current level of 40-plus percent. What does that tell us? It tells us that companies are employing fewer and fewer people, and that wages are declining. The only people making big money are money market players and land speculators.

High Added Value in Medical Parks

There are a lot of folks in the medical community right now who are opposed to the idea of international medical parks. I think this is wrongheaded. Why? Taiwan should offer better conditions for these people to practice their profession here, and it's our fault that it doesn't.

What's more, international medical parks are precisely what could alleviate the problem of declining doctor incomes under the National Health Insurance program. International medical parks would not be constrained by NHI, and rates could be set according to the free market mechanism. Let's say a doctor wants NT$2 million to perform a cataract operation. If somebody is willing to pay it, then do it. That's the market. You go that direction, and you can definitely reduce medical brain drain.

Critics are opposed mostly due to fears that international medical parks would put the squeeze on medical resources for ordinary citizens.

But who would be coming to these international medical parks? Are people with colds and stomach aches going to come to Taiwan for care? No. Diabetes and high blood pressure patients won't either. Ditto for emergency treatment and infectious diseases. Infectious disease cases wouldn't be admitted to Taiwan in the first place.

What kind of patients would international medical parks have? Those seeking cosmetic procedures or complete physicals, as well as elective surgery – non-emergency surgeries that can be scheduled in advance. These could include artificial joints, cataracts, cornea transplants, stomach reductions for obesity, and heart stent operations.

These are all high added-value medical procedures. Taiwan has significant expertise in these areas, and the cost is reasonable. Why not do it? In any event, the impact on Taiwan's basic medical system would be nil.(Compiled by Cindy Li)

Translated from the Chinese by Brian Kennedy