Health Services and Medical Tourism in Taiwan

Abstract

The purpose of the study is to assess if the quality of health care services in Taiwan including affordability of such services in terms of cost, was playing a critical role in promoting medical tourism in Taiwan. Taiwan medical services are well above the accepted standard of industrialized nations. The costs of such medical services are far way below costs in countries such as US, UK, Germany, and Japan among others. This phenomenon has forced patients to travel to Taiwan from such developed nations. The study employed a case study whereby the functional health status of the senior citizen was assessed. 82% of the respondents reported positive health, an indication that they were able to access quality medical care services in time. Age come with diverse medical issues and where the majority of the elderly enjoy good health, it is an indication that there are sufficient and adequate medical infrastructures dedicated to them. Such infrastructures are asset for Taiwan towards becoming a preferred destination for medical tourism.

Introduction

As stated by the World Health Organization (WHO) (1946), being healthy means having a condition of absolute body, psychological, and social welfare and not simply the non-existence of ailments or medical conditions. Human beings’ life expectancy is becoming longer, but numerous health challenges are increasingly noticeable among the elderly populace. Suicide has been rated as among the 10^th causes of death among the elderly population which is influenced by the satisfaction of their living conditions (Chen, 1995). In Taiwan, three factors have been considered to be the major determinants of the health standard among the aging populace. These include sources of earnings, co-existence with family members, and wellness (Chen, 1995). Income dilemmas have been considered to be a significant component of suicide amongst the aging population (Chen, 1995 and Edelheit, 2009). It is conventionally accepted that the adult married children are financially responsible for their elderly parents globally. Difficulties in getting financial support, cohabitation with the rest of the family and health issues cause depression among the aging population which has been an area of concern in Taiwan (Department of Health, 1997).

Taiwan started implementation of its National Health Insurance Plan to secure the health of Taiwan population (Department of Health, 1997). State legislation on behalf of the aging population attempted to improve the lives and promote their general welfare. In regard to this, the senior Citizen Welfare Law was promulgated in 1980. The government has also been working towards promotion of community development which is integrated with resources of social welfare structure aimed at enhancing community welfare service system and efficiently performing social welfare services at all levels (Department of Health, 1997). The most remarkable efforts are in the health care globalization inventiveness where the government aims at encouraging medical tourism and other cross industry association to provide for medical tourists. The government in the precedent few years have been advancing health tourism through highlighting the Taiwan outstanding medical facilities and affordable treatment costs. The Island’s NGO hospitals and clinics association instituted the Taiwan Task Force for medical tourism for integrating medical, government and tourism resources for foreign patients in quest of quality health services.

Literature Review

Medical Tourism

Medical tourism, which is the practice of travelling overseas to look for healthcare has developed considerably in the past decade with an escalating number of nations in quest of becoming key medical services provider for foreign patients. Travelling abroad in search for health care services is not a new occurrence as noted by Ross (2001), that medical/health tourism dated back to the Neolithic and Bronze era in Europe when people went to visit mineral and hot springs. In the 19^th century patients from developing nations would travel to seek medical services that were not available in their countries. Mainly they travelled to European countries and US for diagnosis and treatment. While medical tourism is not a new phenomenon, the contemporary notion of ‘Medical Tourism’ has barely become known in the past ten to fifteen years (Yanos, 2008a). However, unlike in the 21^st century, the travellers in this case are going much further to least developed nations and for medical services that are all-encompassing and of high technology. Medical tourism was branded as a trade undertaking by International Union of Travel Officials in 1973. As a type of global ‘trade in service’, it is categorized as per the classification of ‘trade in service’ of the WTO (World Trade Organization). GATS (General Agreement of Trade in Service) describe four approaches of supply under which services can be commercialized. Even though business in medical services involves the four approaches of supply, medical tourism fits in the second approach which entails the movement of individuals to the state where the services are offered (Yanos, 2008a).

Whereas it is apparent that medical tourism is a financially viable venture that entails ‘trade in services’ from two diverse quarters, health care and tourism, it is not automatically understandable which types of services are covered in healthcare. Some scholars make a distinction between wellness tourism and health tourism arguing that wellness tourism barely entails ‘spa’ and ‘relaxation’ services whereas the health tourism covers all services such as ornamental surgery, optional and indispensable surgery (Caballero-Danell & Mugomba, 2007). All the same, medical tourism is generally not alleged as being narrowed to a small number of explicit treatments. For instance, Deloitte (2008a) describes medical tourism as quite general notion regarding the act of going to other countries seeking out ‘specialized’ or cost-effective medical services, well being and recovery. There are three types of medical tourism which include; invasive, diagnostic and lifestyle. Invasive services entail high technological processes undertaken by an expert; whereas diagnostic processes involve a number of different tests like ‘blood screening’; lifestyle involves ‘wellness’ or recovery services (Bookman &Bookman, 2007).

Indeed, health services cannot at all times be commercialized overseas. For example, a delicate state or a surgery that necessitates follow up treatments on site is one of the challenges that holds back utilization of health services overseas. For a surgery to be simply commercialized, it has to amount to treatment for non acute situation and the client has to be capable of safe travelling; the surgery is to be reasonably uncomplicated and generally executed with least rates of post operation difficulties (Mattoo & Rathindran, 2006). Although the tradability of health services is not relevant to all treatments, a large array of treatment can be acquired through medical tourism (Mattoo & Rathindran, 2006). While at the commencement of the growth of medical tourism trade there were barely a handful of hospital and merely few countries supporting themselves as medical tourism options, in the present day there are hundreds of hospital and clinics and more than 30 different nations offering medical tourism (Edelheit, 2009).

Concerning demand for medical tourism, factors that contribute towards its expansion are very much entwined. Scholars concur that the increasing healthcare expenditure in developed nation together with the accessibility of high quality medical care at considerably lower costs in least developed nations has turn out to be the principal motivation for patients in quest of treatments abroad. As per the costs referenced on the Global Health Tours links, “a bone marrow transplant and a root canal process in the United State rate about two hundred and fifty thousand US dollar and one thousand US dollar respectively as opposed to sixty nine thousand US dollar and one hundred US dollar in India (Caballero-Danell & Mugomba, 2007).” Whereas financial paybacks are fundamental to medical tourism, there are other factors in play. As observed by Mattoo and Rathindran (2006), the majority of medical travels are for processes that are not sufficiently provided by home country health insurance. For instance, health insurance schemes more often than not do not provide for a variety of types of dental or cosmetic surgeries. In nations where they lack extensive national health care, the absence of sufficient medical insurance whatsoever, are a number of the explanations appealing persons to search for treatments overseas (Caballero-Danell & Mugomba, 2007). This is predominantly factual for medical travels from the US where as indicated by the United State Census Bureau 2009 (Chanda, 2002) there were forty six million people not covered by health insurance in 2008. In spite of availability of such national health care schemes, such as in Canada and the UK, persons are still enthusiastic to take medical tourism with an aim of getting suitable treatment and evade long waiting lists at their home country institutions. In such circumstances, patients comprehensively evaluate costs and services provided by other institutions in foreign countries. With the surfacing of ‘state of the art’ equipment and competent practitioners in a number of imperative medical tourism destinations, individuals no longer forfeit quality for costs. There is noteworthy attestation that the upper end of the quality supplies of both qualified practitioners in specialized areas and hospitals in a number of advanced industrializing nation lies well above the lowest satisfactory benchmark in developed nations. As a result, a number of medical tourism destinations are happy to provide first class service at developing world prices (Mattoo & Rathindran, 2006).

Medical tourists in addition prefer to get medical care in a far-off nation as treatment overseas is assumed to assure the client much needed privacy and confidentiality which a number of patients wish particularly when undertaking treatment such as cosmetic surgery. Individuals as well seek overseas services that are considered illegal in their home country. Lastly, when selecting to go to a given nation seeking medical services, there are a number of factors that together with the afore mentioned factors play a great role. For example, geographical and cultural proximity, medical specializations, reputation and portability of health insurance cover (Bookman & Bookman, 2007).

Factors Influencing Patients’ Willingness to Participate in Medical Tourism

Medical tourism is an expanding business with developing nations providing a cheaper and easy access healthcare option for patients from both developed and developing nations. Medical tourism is a consumer motivated tendency, the outcome of a union connecting two well instituted service industries, is seen as a low cost, high quality and easy access of medical services for patients at global level (Helble, 2010). As a result of this attributes, this emerging service industry has achieved global consideration, instigating a large number of patients to think about it as a conceivable options. As developing nations aggressively encourage medical tourism, profound investment is directed towards upgrading the health care structure. As a result, the quality of health care in the nation is advanced and the local populace benefit from this advancement. Nevertheless, this upgrading and the demand predisposed by the overseas patients creates the possibility of amplified health care expenditure and ignored requirements of the local populace, therefore proving derogatory to the health care system of the destination nations (Johnston et al, 2010).

With health care bodies from developing countries uncompromisingly promoting their nation as a medical tourism target to the entire world, insurance bodies and managers in these nations particularly the developed countries are exploiting this occurrence. Managers are giving incentives to their workers to obtain medical care overseas (Pafford, 2009). With alternative of nations such as Costa Rica, Brazil, Malaysia, and Taiwan among others, patients are left to consider their choices and select a country for their health care needs. Whereas, the existing literature debates the repercussions of medical tourism on health care structure, the guiding principles and social arrangement of the patient’s nations and nations providing the health care, there are as well a number of studies carried out to comprehend the choice in the preference of destination. One of the models suggests financial circumstances, political atmosphere and regulatory principles as factors influencing the preference of a nation, expenditure, practitioner competency, superiority of service, and official recognition as influencers for selection of facility (Chanda, 2002). Supply and demand approach (Connell, 2006) of medical tourism proposes together with acknowledgments and ease of access elements like distance and travel cost to preference of a nation and as well as a set of determinants for preference of practitioner. The two models debate the goal features that manipulate the preference of a nation, medical facilities and the doctor. Nonetheless, health care is an incredibly private and significant service, and a great deal of considerations need to be employed in the choice of opting for medical tourism. Health care is an area where the accountability of the result of the service is shared amid the service giver and the client, as the clients’ observance to directions and instructions takes an important function in the achievement of treatment or process. It is as well a psychologically exhausting incident and especially when the health care intervention required, is more multifaceted. A client’s conduct, cognitive and psychological features determine the enthusiasm to co-create, hence accomplishing a successful result is only permissible if the client is at ease in the immediate environment, and is in charge of his/her feelings. Therefore, opting for medical tourism is a prejudiced choice that is affected by cognitive and psychological features that the client is undergoing during the time of making the choice (Chen, 1995).

Taiwan Health Services and facilities

Development and growth of medical tourism has not only been driven by demand but also been influenced by the capabilities of a country to supply high-quality medical care at considerably lower costs. Well-built financial growth in third world nations has led to provision of resources and openings to advance capability and infrastructure limitations that had stalled the expansion of medical tourism sector in the past (Deloitte, 2008a). The concept of global village and advanced communication technology has in addition added to the expansion of this industry (Caballero-Danell & Mugomba, 2007). Progresses in contemporary communication infrastructure during the past years have been critical, playing the role of a catalyst of medical tourism. As a result of this advances, prospective medical tourists are currently in a position to weigh against costs and organize health care travel plans in any country of the world. As Bookman & Bookman (2007) exhibit, emerging telecommunication technology, for instance ‘telediagnosis’ and ‘teleanalysis’, have overcome geographical challenges and have facilitated the cross border trade in medical tourism. A good example of this telecommunication is the internet which allows video conferencing among the patients and the practitioners in addition to real time guided tour of medical facilities (Caballero-Danell, & Mugomba, 2007). However, this does not go without criticism where some experts believe that word of the mouth is the most efficient mode of communication between a patient and a doctor. Other factors that could have led to the expansion of medical tourism comprise the liberalization of ‘trade in service’, the expanding collaboration among private and public sectors and most significantly the successful merging of the tourism and health care sectors (Bookman & Bookman, 2007).

Taiwan health services structure has a comparatively high level of comprehensiveness. Its health system, psychiatric services system and emergency services system projects have been progressively put into cause since 1985 to bring to equity the allocation of medical resources and offer a high level of medical user-friendliness. The National Health Insurance policy, which was initiated in 1995 with an almost ninety nine percent coverage rate, dropped financial barriers for the public to obtain medical services. Taiwan was ranked 13^th out of fifty five countries in world competitiveness for medical services and health medical infrastructure in 2007 by International Institute for Management Development. it was also ranked 2^nd by the Economic Business Intelligence World Health Rankings in 2000. Taiwan positioned similarly with the world’s highly developed countries such as United State, United Kingdom Japan and Germany demonstrating to world assertion of National Health Insurance Policy of Taiwan. This exhibits that Taiwan has comparatively a small number of gaps in this type of service, and provided the tendency towards expanding the demand for multinational medical services, Taiwan is capable of offering health services to population of other nations, going toward growth of health service internationalization (Department of Health, 1997).

The past years have seen an encouraging growth in Taiwan’s contribution in World Health Organization (WHO) dealings. In 2009 WHO incorporated Taiwan as a contributor in the enforcement machinery of the International Health Regulations (IHR) (Ross, 2001). Inclusion in the IHR structure has given Taiwan an advantage of more express contact with the world health bodies and accessibility to first hand information on public health concerns from food safety to spread and management of epidemics. In summary, the Taiwan’s NHI program which has boosted the overall health of its citizens has become an envy of a number of nations since it gives citizens the same access to inexpensive, wide-ranging medical services. This achievement has given Taiwan an opportunity to integrate with WHO related organization to enhance health of people across the globe.

Research Design and Methodology

The study employed a case study design and respondents were selected through a stage strata sampling technique. These strata were urban and rural. 402 respondents were interviewed and each interview lasted for about 40 minutes. Multifunctional information was collected which included cognitive patterns, hearing, vision, behaviour patterns social functioning, informal and formal support service medication services, dental, environmental assessment, visual function, disease diagnoses and physical functioning.

Results and Discussion

Distribution of Participant Characteristic

Table 1 exhibits the background attributes of the participants. The mean age was 71.5 years with a SD of 5.3years. 55.5 percent of the respondents were male with 71.9 percent being married. 36.3 percent had basic level of formal education and a similar figure had no education. 90% of the respondents living at home did not need formal care for their each day routine. For living plans, 48.8% lived with spouse and others, 49% got their financial help from children. On medication, 47.3% were free from medication. In general 82% of the participant acknowledged their health as good.

Table 1

Source: Tina, W. 2010.

Health Status of the Elderly in Taiwan

Table 2 give a summary of healthy status of the senior citizens in Taiwan. Sixteen health issues are listed according to the degree of their severity (3 levels of severity). The levels are for differentiating respondents’ need for health care. Dental service was on the top of the list.

Table 2

Key: * The % does not sum up to 100 % due to rounding off fractional digits.

Source: Tina, W. 2010.

Discussion

The key goal of the study was to establish health status of the senior citizens in Taiwan. 402 randomly selected senior respondents were studied. For a mature grown-up a higher degree of functional health status is an indication of a triumphant aging process. This is an amalgamation of bodily, emotional and social circumstances. Besides, the status shows a blend of quantifiable indicators that mirror all level of their day to day functioning. 82% subjectively accounted a healthy life. Objectively, the respondent exhibited a need in vision, social functioning, informal help, dental, and environmental risks. Although in this study the objective examinations were more reliable than the subjective examinations, the subjective assessments were important for comparison purposes and drawing conclusion. Obtaining 82% of respondents reporting a positive healthy status is not a mere occurrence but a number of factors were assumed to play a critical role. The major factor contributing to good health among the elderly in Taiwan is the National Health Insurance policy. One of the policy measures is the integration of community development and social services which could have played a major role in promoting good health among the elderly. Also, availability of affordable medical services across all population is believed to have boosted the health status of the elderly not constraining their children that are responsible of their income. The government action of providing incentive among the practitioners and nurses availing themselves to work at rural setting could have also promoted good health among the elderly. This is through providing services at cross-range without necessitating travel that is usually a challenge among the elderly.

Conclusion

As exhibited on the above study on functional health status among the elderly in Taiwan, with 82 percent respondents among the elderly reporting positively, it will be inappropriate to classify medical service in Taiwan as below the acceptable standards. This high health status among the elderly then means that Taiwan has the ‘state of art’ to provide for a wide range of health services among the elderly. As noted by Department of Health (1997), stressful states are correlated to physical and mental health. Taiwan through its health policies has combated such stressful circumstance through its National Health Insurance program thus promoting good health among the senior citizen. The policy in the NHI that foreigners who have been in Taiwan for more than 4 months were eligible for the cover, is a good key in promoting medical tourism combined with the quality and ‘state of art’, as well as affordability of the medical services in Taiwan.

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