Tuesday, June 21, 2011

Take a number, please

This morning I had my 16 week check-up with the doctor. Naturally, I was excited to go and see how our little one was making out. But at the same time I was not looking forward to spending my entire morning in the waiting room.

Taiwan has National Health Insurance, a single-payer compulsory social insurance plan, which makes it really cheap to see the doctor. But cheap doesn't always mean good, and there are a few aspects of this health care system which I find quite unpleasant. Spending my morning waiting to see the doctor is one of them.

The wait, is in a large part, a result of the "take-a-number" appointment system. Regardless of whether you are a walk-in, or have an "appointment" everyone is given a number. There are no times assigned to these numbers. So if the doctor begins seeing patients at nine (which doesn't often happen) and you are number 8, like I was today, you probably want to get there sometime between 9 and 9:15 so you can sign in and do all of the preliminary things. Of course, like I should have known, by 9:30 the doctor still hadn't called in the first patient. I didn't get in to see him until 10:15. An hour of waiting? Not so bad. I have been, on multiple occasions, waiting to see that doctor for 2 1/2 to 3 hours only to be told to come back after lunch, because he's delivering a baby now.

But I can never figure out what the heck is holding up progress, because if he saw every patient for as little time as he sees me, then he would have all of us done and plenty of time for lunch. This brings me to another issue, and quite an important one, time with the doctor. I always feel like I am being rushed through there. The doctor doesn't spend much time consulting with me before I'm whisked away into the ultrasound room. There we get a little bit more time with him, but I still feel a sense of urgency coming from him. Often he is out the door before Jonathan and I can even think of any questions we might have, and then we're just left sitting there, looking at each other and saying, "uhh, did you get all that?"

I guess when you are in as high demand as he is, things need to go at warp speed. After all, he is a fairly "famous" doctor in Kaohsiung, and I already explained how people flock to famous places. But I think besides being in high demand, there is another issue affecting the speed at which things are done there, and that is patient turnover. When you operate a small hospital where each patient only pays $3 or $4 per visit in addition to whatever is received from the insurance program, you need to have a fairly large number of people coming through daily in order to make it work. Furthermore, doctors may receive bonuses for maintaining a higher patient load. A somewhat funny example of the absurdity of this high turnover system is one of Jonathan's students- a psychiatrist, who has so many patients (for whatever reason) that he can only spend five minutes with each of them. Can you imagine going in for psychiatric counseling and only having 5 minutes with which to untangle your issues??

But some offices employ various techniques to ensure the steady flow of patients. For example, if you have a problem, like an eye infection or some kind of skin rash, some doctors will recommend that you come back every week to have it checked on. Sure, they could just be cautious and concerned, but sometimes I think the number of times they want you to come back and "check-up" is a bit excessive. Another way dentists, for example, get patients to keep coming back is to not address all of the problems in the mouth at once. I have had students here, who have been back to the dentist 2 or 3 times for a routine wisdom teeth removal. Likewise, when I had two cavities needing fillings, the dentist would only fill one of them at a time.

Please do not read this as an attack on doctors here in Taiwan. I know quite a few personally and they are all very dedicated and caring professionals. Even the doctor I am seeing for my prenatal care is still, despite his business practices, a good doctor. But, in my opinion, the constraints of the National Health Insurance policy create a lot of service issues for health care facilities. The doctors, while being very good at what they do, must employ this way of doing business in order to make it profitable for their facility, often resulting in a lower quality of care for the individual.