林行止—政府负责任 市民尽义务
2009年4月29日
一、
世卫组织已把“流行疫症警戒级别”提高至证实病毒会人传人的第四级，预示猪流感已在各地扩散；面对这种可能蔓延全球的疫症，政府和人民似乎有二种“误信”（也许有人明知不可信却为自我安慰和令大众安心而不得不表示相信），其一为“特敏福”和“乐感清”是特效药；其一为猪肉会传播病毒。
“特敏福”及“乐感清”对不断变异的病毒都无疗效（严格来说是疗效不足百分之五），但在针对Ｈ１Ｎ１（及Ｈ３Ｎ２）病毒的特效疫苗未发现前，卫生当局及医院只能贮备这二种不算完全无用的成药；非常明显，如果公私医疗机构和盘托出世卫的有关实验报告（二十七日本栏；同日有“网友”指出统计见 who.int/csr/disease/influenza/H1N1），则极可能引致公众恐慌；根据世卫的实验，今年一月在证实染上Ｈ１Ｎ１的一千三百六十二宗病例中，对“特敏福”呈抗药性的有一千二百五十一宗，等于这种“特效药”只对约百分之五患者有效……。不过，在无法可想的情形下，当局只能以储存足量的“特敏福”来安抚民心！这种事实，炒卖相关药厂股票者应留意。
猪流感和吃猪肉是二码子事，世卫近日多次强调只要“适当地煮熟”（华氏一百六十度足以杀死猪肉中一切细菌和病毒），猪肉绝对无害，因此，该组织建议别赴墨西哥旅行而没有建议禁食猪肉。世界第一个禁止猪肉进口的似乎是菲律宾，去周六其农业部长作这项宣布时，指出这只是“预防性措施”，同时强调“没有证据显示猪肉带有病毒”。有些国家如俄罗斯去周日宣布禁止猪肉进口，其真正理由当然不是担心猪肉会传播病毒（卫生当局肯定读过世卫的报告），这样做的目的不外“借刀杀人”，因为设法减少肉类进口（近年多次提高肉类进口关税）是俄罗斯扶助国内畜牧业的政策。
顺便一提，人类患猪流感的致命率（ＣＦＲ），以墨西哥为例，约百分之十，猪只染此病毒的死亡率更低至在百分之一至三之间；然而，这是指“猪传人”的病例，假如是“人传猪”─带病毒的人把之传给猪只，后者的死亡率“极高”；医家虽未提供具体数据，但一九一八年杀人无数（五千万至一亿）的“大流感”，引致三十年代“猪瘟”令全球死掉以千万计猪只，便是“人传猪”引致。
二、
在对付猪流感上，特区政府汲取○三年沙士爆发时张皇失措造成大量死亡的惨痛经验，迅速定出多项预防措施，包括每天下午召开“四三○”记者会公布有关情况、成立跨部门督导委员会，医管局同时做好种种相关部署……，食物及卫生局局长周一岳因此信心满满，说“我们正在等待第一个病人来港”！
港府做好应变措施，不仅显示了办事认真和谨慎，同时反映了履行道德及社会责任的决心；惟其能否妥善地“击退”猪流感，有待事实说明。
作为和政府一样负责任的市民，在猪流感风声鹤唳之下应怎样做才能分担当局肩上的重担且能保持良好健康状态？专家（四月号《华盛顿月刊》的提示是密切留意有关消息及资讯、听从政府的“劝谕”（如不去问题地区旅行及“众地勿企”等）、做好个人基本卫生（如经常洗手及勿当众咳嗽等）、发现身体在异状（本人或家人）要马上就医（愈早就医“特敏福”药效愈大）、做好在一般时间不外出家居的准备（如贮足一定数目的日常食用品）。
在真正有效的“特效药”未发现前，上述种种是负责任公民应尽的义务。
三、
海外论者经常批评中国官僚系统敷衍塞责贪污腐化（沙士期间尤为如此），没想到墨西哥的情况不相伯仲。迄今为止，猪流感致命者均发生于墨西哥（墨西哥外一共有约三百宗病例），这究竟是该国医院设备落后、对患者疏于照顾还是药物不足？这些问题都有正面答案。墨西哥的问题，据四月五日《La Jornada》日报的报道（四月二十七日英国《卫报》有强调死了数名婴孩的特稿），猪流感在二月间已爆发，但医院管理不善、医生处理不当及官员贪腐成风，不仅令这种新流感被视为肺炎、气管炎，而且上呈的病患者数字大幅缩水；从可能染上猪流禽却报称死于其他呼吸系统疾病的人数推测，染病人数可能高达一万五千多人。
上引日报报道，猪流感二月间在人口三千多的小镇La Gloria 发现，该村以养猪场出名，但其供猪只“打滚”的浅池有如无遮猪厕，臭气冲天、苍蝇蔽日，该村有六成人口患上“疑似猪流感”……。墨西哥猪流感情况肯定远较外电所说的严重。
Thursday, April 30, 2009
Wednesday, April 22, 2009
港迷债丑闻后续：太阳报社评—坐视毒债祸民 先知惨过无知
主题:港迷债丑闻后续：太阳报社评—坐视毒债祸民 先知惨过无知
太阳报社评—坐视毒债祸民 先知惨过无知
2009-04-15
立法会引用权力及特权法调查雷曼迷债事件，演变成一场财金官员争相卸责的闹剧。金融管理局总裁任志刚昨日出席立法会聆讯时，仍在死撑，多番否认对银行监管不足，强调自己早在○六年已就金融衍生产品可能引发的风险作出多次预警，并要求银行提高相关投资产品的风险评级。他并声称金管局无权参与审批金融产品的文件和章程。
任志刚的一番伟论，委实令人摸不着头脑。如果金管局果真如此先知先觉，为何类似雷曼这种毒债仍可卖到成行成市？为何数万市民会血本无归？
事实胜于雄辩，不妨看看本报去年跟进的一宗案例。去年二月，债券苦主林先生到银行做定期存款，在银行游说下购入被职员称为“保本”的雷曼迷债。林先生回家后细阅文件，发现所购入的迷债原来是高风险投资产品，他认为银行销售手法存在误导，乃于四月十五日向金管局投诉，要求局方介入调查，讵料金管局花了近五个月时间跟进他的投诉后，竟说“没有足够理据支持去展开正式调查”。任志刚自称○六年已发现迷债问题，不知从何说起。
显而易见，任志刚根本是在推卸责任。金管局拥有全面详尽的市场资讯，能够预早察觉金融市场所潜伏的危机，不足为怪。然而作为本港金融业的主要监管机构，局方既然发现问题，实有责任及时介入，加强监管，阻止问题产品流入市面，而不是单单发表几句评论，聊以塞责。当局放纵雷曼迷债横行市面，已是难辞其咎，而金管局既知问题之所在却没作跟进，则更是罪加一等！
不难想像，如果金管局对金融产品及时作出规管，必可防止更多市民中招。但令人失望的是，局方竟对毒债销售视而不见、见而不理，坐视市民纷纷堕入陷阱，到了雷曼爆煲后，他们又将责任统统推给银行，“劝喻”银行与客户达成回购和解，自己则置身事外。如今在立法会跟进下，金管局又以“先知先觉”自居，和证监会互相推卸，把本身的责任推得一干二净。
诚如有议员指出，“迷你债券”的名称本身已具有误导性。有议员质疑金管局明知迷债产品存在高风险，却没有阻止相关的销售广告。事实上，这种高风险产品在欧美地区只会卖给专业投资者，但在香港，却可对包括退休长者、残疾人士在内的普罗大众大销特销，这反映的已经不只是个别银行职员的不良销售行为，而是整个金融监管制度的严重漏洞，以及相关部门的严重失职。
雷曼迷债事件告诉我们，表面上，本港金融业是由金管局及证监会“一业两管”，事实上，却是处于“金管不管，证监不监”的真空状态。更加离谱的是，迷债爆煲迄今，人们只见两个部门互相扯皮，至今不见一名官员主动承认责任。市民寄望立法会介入调查事件，就是希望立法会能主持公道，追究失职官员的责任，同时督促当局堵塞监管漏洞，绝对叉他们再次蒙混过关！
雷曼兄弟倒闭，迷债炸弹爆发，掀起全城风雨，造成难以挽回的损失。然而一众财金官员疏于监管、只顾推诿卸责，这对香港这个所谓金融中心的损害，犹甚于雷曼事件。
太阳报社评—坐视毒债祸民 先知惨过无知
2009-04-15
立法会引用权力及特权法调查雷曼迷债事件，演变成一场财金官员争相卸责的闹剧。金融管理局总裁任志刚昨日出席立法会聆讯时，仍在死撑，多番否认对银行监管不足，强调自己早在○六年已就金融衍生产品可能引发的风险作出多次预警，并要求银行提高相关投资产品的风险评级。他并声称金管局无权参与审批金融产品的文件和章程。
任志刚的一番伟论，委实令人摸不着头脑。如果金管局果真如此先知先觉，为何类似雷曼这种毒债仍可卖到成行成市？为何数万市民会血本无归？
事实胜于雄辩，不妨看看本报去年跟进的一宗案例。去年二月，债券苦主林先生到银行做定期存款，在银行游说下购入被职员称为“保本”的雷曼迷债。林先生回家后细阅文件，发现所购入的迷债原来是高风险投资产品，他认为银行销售手法存在误导，乃于四月十五日向金管局投诉，要求局方介入调查，讵料金管局花了近五个月时间跟进他的投诉后，竟说“没有足够理据支持去展开正式调查”。任志刚自称○六年已发现迷债问题，不知从何说起。
显而易见，任志刚根本是在推卸责任。金管局拥有全面详尽的市场资讯，能够预早察觉金融市场所潜伏的危机，不足为怪。然而作为本港金融业的主要监管机构，局方既然发现问题，实有责任及时介入，加强监管，阻止问题产品流入市面，而不是单单发表几句评论，聊以塞责。当局放纵雷曼迷债横行市面，已是难辞其咎，而金管局既知问题之所在却没作跟进，则更是罪加一等！
不难想像，如果金管局对金融产品及时作出规管，必可防止更多市民中招。但令人失望的是，局方竟对毒债销售视而不见、见而不理，坐视市民纷纷堕入陷阱，到了雷曼爆煲后，他们又将责任统统推给银行，“劝喻”银行与客户达成回购和解，自己则置身事外。如今在立法会跟进下，金管局又以“先知先觉”自居，和证监会互相推卸，把本身的责任推得一干二净。
诚如有议员指出，“迷你债券”的名称本身已具有误导性。有议员质疑金管局明知迷债产品存在高风险，却没有阻止相关的销售广告。事实上，这种高风险产品在欧美地区只会卖给专业投资者，但在香港，却可对包括退休长者、残疾人士在内的普罗大众大销特销，这反映的已经不只是个别银行职员的不良销售行为，而是整个金融监管制度的严重漏洞，以及相关部门的严重失职。
雷曼迷债事件告诉我们，表面上，本港金融业是由金管局及证监会“一业两管”，事实上，却是处于“金管不管，证监不监”的真空状态。更加离谱的是，迷债爆煲迄今，人们只见两个部门互相扯皮，至今不见一名官员主动承认责任。市民寄望立法会介入调查事件，就是希望立法会能主持公道，追究失职官员的责任，同时督促当局堵塞监管漏洞，绝对叉他们再次蒙混过关！
雷曼兄弟倒闭，迷债炸弹爆发，掀起全城风雨，造成难以挽回的损失。然而一众财金官员疏于监管、只顾推诿卸责，这对香港这个所谓金融中心的损害，犹甚于雷曼事件。
Taiwan World Class Medical Insurance-- Translated
The article written by Dong Qing Feng published in the most recent issue of Asiaweek has pointed out that Taiwan's Medical insurance system is regarded as one of the best model for the world. From Medical demand, Medical supply etc. it has been praised and ranked second only to Sweden. Few of the main reasons for such high ranking include the hardworking doctors, low wages for medical staffs, few medical disputes and compensations and most importantly, most of the medical institutions are run and controlled by the government.
The report points out that last year, Nobel Prize winner, Economic Professor of US Princeton University and column writer for New York Times, Professor Paul Krugman, has praised Taiwan's Medical Insurance system in New York Times and urged the Americans to emulate such system.
Krugman believes that the Taiwan Medical Insurance system can provide a good example for all Americans to be insured within their economic means. He reiterates that within a short period of six years, the growth in the number of Taiwanese being medically insured has raised from less than 60% to 97%. Besides, the cost for all Taiwanese to be insured is very low and it takes population and income growth into account. Even if the cost of medical care increase, the increase will be insignificant.
The Taiwan medical insurance system was implemented in 1st March 1995. It was one of the greatest achievement of the KMT when Lian Zhan was the Prime Minister then. It becomes famous in the world for providing low medical insurance premium, wide medical coverage and convenience resulting in high subscription rate by Taiwanese. Taiwan Medical Insurance scheme consolidated workers, laborers and farmers medical insurance payment and created a single entity medical insurance for all. It implements a single payment channel and a gross payment system.
This National Medical Insurance scheme embrace the spirit of social insurance, which is risk sharing and under the fundamental guiding principle of mutual help, the young will earn money to take care of the medical risks of the aged. In doing so, it achieves mutual aid across different generations and races. It also creates a huge health database that could be used by healthcare research. On the other hand, the administration cost has been kept under 2% and that is why it has been praised internationally.
In 2000, EIU has ranked Taiwan's Medical Insurance scheme as number two under medical demand and supply, second only to Sweden in the whole world. The ABC has praised Taiwan's Medical Insurance scheme in one of its program broadcast in 2003, pointing out the fact that with a monthly medical insurance premium of US$20 and an average cost of US$4 to US$10 for every medical visit, you could make appointment to any hospital with any preferred doctors of your choice in Taiwan. There are at least 50 countries around the world that have paid visits to Taiwan to study its Medical Insurance scheme in recent years.
Taiwan Medical Insurance Scheme has been well known to be value for money. Base on their income, Taiwanese will pay a token amount of insurance premium every month and they will be able to enjoy all kinds of medical services. Regardless of rich or poor, big hospitals or small clinics, all will receive the same level of medical services. All will receive equal treatment. Even if the rich wish to pay more for additional privileged services, it will be prohibited. Besides, it is very convenient to get medical services there, with big number of hospitals and clinics availability all throughout Taiwan. You can pick and choose your choice of hospital or clinic without any need of doctor's recommendation.
The Medical Insurance is not solely born by the people. Private companies and the government will have to share the cost of the premium as well. Those companies that bought workers' insurance for their employees will have to pay for their medical insurance as well. This is due to the fact that such insurance premium will include workers' insurance and medical insurance. The present law dictates that employers will have to bear 60% of their workers' medical insurance, employees and their family members will bear 30% while the government will bear 10%.
Taiwan Medical Insurance Scheme's premiums are based on income classification. The premiums are charged according to 10 different classes of income. For example, those who earn less than NT$17280 (about US$500) will pay only NT$600 as monthly premium. Those with monthly income more than NT$131700, they will pay a monthly premium of NT$5400.
Foreign workers are included in the Medical Insurance Scheme.
Due to the fact that the National Medical Insurance Scheme is compulsory for all, everyone will have to be admitted into the Medical Insurance Scheme. This will include foreign students, migrants and even foreign workers. Its core value is “Big illness for Hospitals, small illness for small clinics” . Everyone who seek medical care, apart from paying the basic administration fee, patients will have to bear part of the medical cost.
Ex-DPP Legislative Yuan member Sheng Fu Xiong has a heart operation, warded for 4 days. The operation implanted a blood vessel widener for him. He paid about NT$20000 (about US$600), the medical insurance has helped him paid a few hundred dollars. Such operation will cost more than a million of New Taiwan dollars without medical insurance.
Taiwan Medical Insurance is very Cheap!
As a medical doctor, Sheng Fu Xiong is one of the few in Legislative Yuan who are regarded as those who have put in lots of effort in researching on the Medical Insurance Scheme back then. He pointed out that the insurance premium that each Taiwanese has to pay is about one sixth to one eight of US medical insurance premiums and this is very cheap!
Taiwan's Medical Insurance Scheme is the creation of Harvard professor Xiao Qing Lun and this creation is based on the study of Canada's united insurance system. However, Canada's medical insurance scheme is basically a failure, why does Taiwan's scheme a success then? Sheng Fu Xiong pointed out that firstly, Taiwan doctors are just too hardworking. Many doctors has to see 120 patients a day (while in US, the average is only 30), this is very rare and unique in the world. Secondly, Taiwan's medical staff, apart from doctors, like nurses, physiotherapists, nutrionists, psychiatrists, pharmacists etc., are fewer in comparison and their wages are lower. Take nurses for example, their pay is only 20% of US nurses. Thirdly, there are few medical disputes in Taiwan, there are less medical related lawsuits. Even if there are, even if the doctor lost the case, the compensation amount is not high. Compensation for death caused by erroneous diagnosis is at most NT$1m to NT$2m, some are even below NT$1m. Forth, all American medical institutions are listed company, the pressure of profitability is higher. Taiwan's medical institutions are prohibited from listing in the stock exchange, most of them are run and subsidized by the government.
In comparison, Canada's medical insurance system does not have all these advantages. Sheng Fu Xiong pointed out that most important of all, Canada does not have efficiency. If a patient needs an operation that is deemed as non-urgent, like an operation on hip joint, they will need to wait for at least 6 months. In Taiwan, the same operation will only take 1 week to be completed.
Sheng Fu Xiong revealed that a few years ago, Hong Kong government was considering of implementing a system similar to Taiwan's Medical Insurance scheme. Xiao Qinglun has travelled to Hong Kong to explain the scheme to the Hong Kong officials. He was engaged by the Hong Kong government to do a feasibility study there but in the end, he recommended against implementing such a scheme in Hong Kong. The Hong Kong government has accepted his recommendation. “I feel that it is right not to implement it” This is because this system could only be successful in Taiwan, it will fail in other parts of the world. “This is the fruit of Taiwan's special circumstances”.
Hong Kong's system is the middle path between Taiwan and US.
Sheng Fu Xiong said that one of the main reason that it is not suitable for Hong Kong to emulate Taiwan's Medical Insurance scheme is that Hong Kong doctors are not as hardworking as Taiwan's, there are more medical staffs than Taiwan, salaries are higher than Taiwan and there are more medical disputes than Taiwan.” He said that Hong Kong's system is a middle path between Taiwan and US. It has all the bad points that US has but the problems are not as serious as US. Hong Kong does not have the good points that Taiwan has, like hardworking doctors, low compensation for medical dispute, medical institutions are not listed on stock exchange...etc.
Sheng Fu Xiong criticize Krugman as an amateur. Although Krugman is a Liberal but he has socialist influence in his heart. Thus, he does not discount government intervention totally. However, Taiwan's Medical Insurance scheme is a single provider and it under heavy influenced by the governmental system. Besides, it is not a multi-insurance scheme but a unison insurance scheme and this is the role played by the government. He only sees the beauty of Taiwan's Medical Insurance Scheme but not the potential problems. It is due to the fact that the Taiwan Medical Insurance scheme is based on a collapsible structure that it needs to be reformed.
Taiwan government has paid nearly NT$400Billion per year but medical experts criticize that the medical wastage every year amount to Nt$10billion resulting in the Medical Insurance scheme recording deficits every year. Sheng Fu Xiong pointed out that the potential worries of the Medical Insurance scheme is “the growth of our premium collections could not catch up with the growth of the medical expenses.” Thus every time when the accounts are balanced, 3 years later it will become a deficit again. In another words, expenses are always bigger than premium collections and this is due to the lack of restrains and the spirit of free market principles. Taiwanese like to visit hospital, even for a small flu, they would visit the big hospital. Some mother would bring their children to GP in the morning. If there is no significant improvement, they will bring them to otolaryngology in the afternoon. This is almost impossible in US.
One of the main reason for such high medical expenses for the Medical Insurance Scheme is that Taiwanese are used to taking medicine. For the whole of last year, the expenses on medicine by the Medical Insurance scheme has reached NT$125Billion, an increase of 6.9% from the previous year. Among these expenses, medicine for hypertension, glucagon and statin has amounted to NT$32.3Billion. The top medicine “MaiYou” alone, which is used mainly for treatment of hypertension and strengthening the heart functionality, has consistently top the list of medicine for 8 years, cost almost NT$4.5Billion per year.
Due to popular demand, I have decided to spend some time in translating the Chinese article on Taiwan's World Class Medical Insurance here.
Goh Meng Seng
Taiwan Medical Insurance scheme has the mission to provide healthcare for everyone in Taiwan. Although the government has claimed 70% approval rate from the people, but it could not just brush off the potential threats of deficits. The problems of limited medical resources, deficits of the Medical Insurance scheme etc has cast doubts on how long this Medical Insurance Scheme could last.
There are merits in Taiwan Medical Insurance Scheme but we should not just look at the glamorous flowers that it glooms and try to copy it wholesale. We must do thorough examination of its specialty, learn from its good points and try to manage the bad. Only then could we avoid deficits and improve on providing healthcare to all Taiwanese.
Translated by Goh Meng Seng
The report points out that last year, Nobel Prize winner, Economic Professor of US Princeton University and column writer for New York Times, Professor Paul Krugman, has praised Taiwan's Medical Insurance system in New York Times and urged the Americans to emulate such system.
Krugman believes that the Taiwan Medical Insurance system can provide a good example for all Americans to be insured within their economic means. He reiterates that within a short period of six years, the growth in the number of Taiwanese being medically insured has raised from less than 60% to 97%. Besides, the cost for all Taiwanese to be insured is very low and it takes population and income growth into account. Even if the cost of medical care increase, the increase will be insignificant.
The Taiwan medical insurance system was implemented in 1st March 1995. It was one of the greatest achievement of the KMT when Lian Zhan was the Prime Minister then. It becomes famous in the world for providing low medical insurance premium, wide medical coverage and convenience resulting in high subscription rate by Taiwanese. Taiwan Medical Insurance scheme consolidated workers, laborers and farmers medical insurance payment and created a single entity medical insurance for all. It implements a single payment channel and a gross payment system.
This National Medical Insurance scheme embrace the spirit of social insurance, which is risk sharing and under the fundamental guiding principle of mutual help, the young will earn money to take care of the medical risks of the aged. In doing so, it achieves mutual aid across different generations and races. It also creates a huge health database that could be used by healthcare research. On the other hand, the administration cost has been kept under 2% and that is why it has been praised internationally.
In 2000, EIU has ranked Taiwan's Medical Insurance scheme as number two under medical demand and supply, second only to Sweden in the whole world. The ABC has praised Taiwan's Medical Insurance scheme in one of its program broadcast in 2003, pointing out the fact that with a monthly medical insurance premium of US$20 and an average cost of US$4 to US$10 for every medical visit, you could make appointment to any hospital with any preferred doctors of your choice in Taiwan. There are at least 50 countries around the world that have paid visits to Taiwan to study its Medical Insurance scheme in recent years.
Taiwan Medical Insurance Scheme has been well known to be value for money. Base on their income, Taiwanese will pay a token amount of insurance premium every month and they will be able to enjoy all kinds of medical services. Regardless of rich or poor, big hospitals or small clinics, all will receive the same level of medical services. All will receive equal treatment. Even if the rich wish to pay more for additional privileged services, it will be prohibited. Besides, it is very convenient to get medical services there, with big number of hospitals and clinics availability all throughout Taiwan. You can pick and choose your choice of hospital or clinic without any need of doctor's recommendation.
The Medical Insurance is not solely born by the people. Private companies and the government will have to share the cost of the premium as well. Those companies that bought workers' insurance for their employees will have to pay for their medical insurance as well. This is due to the fact that such insurance premium will include workers' insurance and medical insurance. The present law dictates that employers will have to bear 60% of their workers' medical insurance, employees and their family members will bear 30% while the government will bear 10%.
Taiwan Medical Insurance Scheme's premiums are based on income classification. The premiums are charged according to 10 different classes of income. For example, those who earn less than NT$17280 (about US$500) will pay only NT$600 as monthly premium. Those with monthly income more than NT$131700, they will pay a monthly premium of NT$5400.
Foreign workers are included in the Medical Insurance Scheme.
Due to the fact that the National Medical Insurance Scheme is compulsory for all, everyone will have to be admitted into the Medical Insurance Scheme. This will include foreign students, migrants and even foreign workers. Its core value is “Big illness for Hospitals, small illness for small clinics” . Everyone who seek medical care, apart from paying the basic administration fee, patients will have to bear part of the medical cost.
Ex-DPP Legislative Yuan member Sheng Fu Xiong has a heart operation, warded for 4 days. The operation implanted a blood vessel widener for him. He paid about NT$20000 (about US$600), the medical insurance has helped him paid a few hundred dollars. Such operation will cost more than a million of New Taiwan dollars without medical insurance.
Taiwan Medical Insurance is very Cheap!
As a medical doctor, Sheng Fu Xiong is one of the few in Legislative Yuan who are regarded as those who have put in lots of effort in researching on the Medical Insurance Scheme back then. He pointed out that the insurance premium that each Taiwanese has to pay is about one sixth to one eight of US medical insurance premiums and this is very cheap!
Taiwan's Medical Insurance Scheme is the creation of Harvard professor Xiao Qing Lun and this creation is based on the study of Canada's united insurance system. However, Canada's medical insurance scheme is basically a failure, why does Taiwan's scheme a success then? Sheng Fu Xiong pointed out that firstly, Taiwan doctors are just too hardworking. Many doctors has to see 120 patients a day (while in US, the average is only 30), this is very rare and unique in the world. Secondly, Taiwan's medical staff, apart from doctors, like nurses, physiotherapists, nutrionists, psychiatrists, pharmacists etc., are fewer in comparison and their wages are lower. Take nurses for example, their pay is only 20% of US nurses. Thirdly, there are few medical disputes in Taiwan, there are less medical related lawsuits. Even if there are, even if the doctor lost the case, the compensation amount is not high. Compensation for death caused by erroneous diagnosis is at most NT$1m to NT$2m, some are even below NT$1m. Forth, all American medical institutions are listed company, the pressure of profitability is higher. Taiwan's medical institutions are prohibited from listing in the stock exchange, most of them are run and subsidized by the government.
In comparison, Canada's medical insurance system does not have all these advantages. Sheng Fu Xiong pointed out that most important of all, Canada does not have efficiency. If a patient needs an operation that is deemed as non-urgent, like an operation on hip joint, they will need to wait for at least 6 months. In Taiwan, the same operation will only take 1 week to be completed.
Sheng Fu Xiong revealed that a few years ago, Hong Kong government was considering of implementing a system similar to Taiwan's Medical Insurance scheme. Xiao Qinglun has travelled to Hong Kong to explain the scheme to the Hong Kong officials. He was engaged by the Hong Kong government to do a feasibility study there but in the end, he recommended against implementing such a scheme in Hong Kong. The Hong Kong government has accepted his recommendation. “I feel that it is right not to implement it” This is because this system could only be successful in Taiwan, it will fail in other parts of the world. “This is the fruit of Taiwan's special circumstances”.
Hong Kong's system is the middle path between Taiwan and US.
Sheng Fu Xiong said that one of the main reason that it is not suitable for Hong Kong to emulate Taiwan's Medical Insurance scheme is that Hong Kong doctors are not as hardworking as Taiwan's, there are more medical staffs than Taiwan, salaries are higher than Taiwan and there are more medical disputes than Taiwan.” He said that Hong Kong's system is a middle path between Taiwan and US. It has all the bad points that US has but the problems are not as serious as US. Hong Kong does not have the good points that Taiwan has, like hardworking doctors, low compensation for medical dispute, medical institutions are not listed on stock exchange...etc.
Sheng Fu Xiong criticize Krugman as an amateur. Although Krugman is a Liberal but he has socialist influence in his heart. Thus, he does not discount government intervention totally. However, Taiwan's Medical Insurance scheme is a single provider and it under heavy influenced by the governmental system. Besides, it is not a multi-insurance scheme but a unison insurance scheme and this is the role played by the government. He only sees the beauty of Taiwan's Medical Insurance Scheme but not the potential problems. It is due to the fact that the Taiwan Medical Insurance scheme is based on a collapsible structure that it needs to be reformed.
Taiwan government has paid nearly NT$400Billion per year but medical experts criticize that the medical wastage every year amount to Nt$10billion resulting in the Medical Insurance scheme recording deficits every year. Sheng Fu Xiong pointed out that the potential worries of the Medical Insurance scheme is “the growth of our premium collections could not catch up with the growth of the medical expenses.” Thus every time when the accounts are balanced, 3 years later it will become a deficit again. In another words, expenses are always bigger than premium collections and this is due to the lack of restrains and the spirit of free market principles. Taiwanese like to visit hospital, even for a small flu, they would visit the big hospital. Some mother would bring their children to GP in the morning. If there is no significant improvement, they will bring them to otolaryngology in the afternoon. This is almost impossible in US.
One of the main reason for such high medical expenses for the Medical Insurance Scheme is that Taiwanese are used to taking medicine. For the whole of last year, the expenses on medicine by the Medical Insurance scheme has reached NT$125Billion, an increase of 6.9% from the previous year. Among these expenses, medicine for hypertension, glucagon and statin has amounted to NT$32.3Billion. The top medicine “MaiYou” alone, which is used mainly for treatment of hypertension and strengthening the heart functionality, has consistently top the list of medicine for 8 years, cost almost NT$4.5Billion per year.
Due to popular demand, I have decided to spend some time in translating the Chinese article on Taiwan's World Class Medical Insurance here.
Goh Meng Seng
Taiwan Medical Insurance scheme has the mission to provide healthcare for everyone in Taiwan. Although the government has claimed 70% approval rate from the people, but it could not just brush off the potential threats of deficits. The problems of limited medical resources, deficits of the Medical Insurance scheme etc has cast doubts on how long this Medical Insurance Scheme could last.
There are merits in Taiwan Medical Insurance Scheme but we should not just look at the glamorous flowers that it glooms and try to copy it wholesale. We must do thorough examination of its specialty, learn from its good points and try to manage the bad. Only then could we avoid deficits and improve on providing healthcare to all Taiwanese.
Translated by Goh Meng Seng
Monday, April 13, 2009
World Class Medical Insurance Schem- Taiwan
The following is a news article on Taiwan's Medical Insurance Scheme which is deemed as the most successful one in Asia, second to Sweden in the whole world. Yes, they do not need a multi-million annual salaried Heath Minister to come up with this. They do not need Health Minister to suggest vividly that citizens looking for cheap medical care should go across the causeway.
新华网消息最新一期亚洲周刊发表童清峰的文章指出，台湾健保制度被认为是全球典范，从医疗需求、医疗供给等项目，都获称赞，在国际排名第二，仅次于瑞典，其中主要的原因是医生卖力、医护人员薪水低、医疗纠纷少及赔偿有限，还有医疗事业大部分公营，便于政府控制。
报道说，去年诺贝尔经济学奖得主、美国普林斯顿大学经济系教授兼《纽约时报》专栏作家克鲁曼（Paul Krugman），曾于《纽约时报》专栏大赞台湾健保制度，要美国人效法。
克鲁曼认为，台湾健保制度可“提供美国全民在经济上纳保的范例”。强调短短的六年间，台湾人民的健保纳保率快速成长，从不到六成冲到九成七。而且“台湾全民纳保的成本很低，考量人口增加和收入成长，就算整体医疗费用有任何成长，也不多”。
台湾健保制度于1995年3月1日正式实施，是国民党时代连战担任“阁揆”时最亮丽的政绩，它以被保险人口投保率高、投保费率低、给付范围广及就医方便而闻名于国际。台湾健保统合工劳农保医疗给付，建立单一体制的全民健康保险，采行单一支付管道，实施总额支付制度。
全民健保具有社会保险的精神，即所谓风险分摊，在自助互助的基本理念下，年轻人赚钱分担老幼的医疗风险，达到年龄族群和世代互助，而且形成庞大健康资料库，便利卫生研究工作；而行政费用维持在百分之二以下，因而极受国际推崇。
《经济学人信息部》（EIU）在2000年就医疗需求、医疗供给等项目，将台湾医疗保健评为世界第二，仅次瑞典。美国广播公司在 2003年制作节目盛赞台湾的健保，指出每人每月平均付20美元的保费，每次看诊平均付挂号费4到10美元，就可以到特约医院找任何医师看病。近年来，来台湾取经的国家不下50个。
台湾健保堪称价廉物美，民众根据薪资多寡，每月只要付少少的钱，即可享受到各样的医疗服务，不论贫富贵贱，去大医院或小诊所，所受到的医疗服务全都一样，一视同仁，有钱人纵使想多付钱获取额外服务，也不被允许；而且就医便利，医院、诊所到处都是，自己可以选择要在哪里就诊，无须医师指定。
健保不是被保险者付费而已，企业和政府也都要分摊，台湾公司行号有替员工加劳保就一定要替员工加健保，因为两者的加保金额都是以劳保加保金额为依据，且健保是跟着劳保走。现行法令规定雇主每月为员工负担之健保费为六成，员工与眷属自付三成，政府负担一成。
台湾健保投保金额采取分级制，根据薪资等级分为十组，例如月薪最低在1万7280元（约合500美元）以下者，每月缴纳600元；月薪最高13万1700者，每月缴5400元。
外劳也被纳入健保
由于全民健保是强制性保险，无论何人都必须参加健保，包括留学生、移民者，甚至外劳等都纳入。它主要的精神是“大病看大医院，小病看诊所”，任何人看病，除了支付挂号费外，病人还须分摊部分的医疗费用。
前民进党“立委”沈富雄前年在台大医院动了心导管手术，住院四天，装了一枝血管支架，他只付了新台币近2万元，健保帮他付了几十万，若无健保，同样的手术得花费一百多万元。
台湾健保“太便宜了”
医师出身的沈富雄，是当年“立法院”中少数被公认对健保下过工夫研究者，他指出，台湾每个人所缴的健保费大概是美国的六分之一到八分之一，“太便宜了”。
台湾健保是哈佛教授萧庆伦的构想，这个构想是参考加拿大单一保险人制度，但加拿大的健保基本上是失败的，为什么台湾能成功？沈富雄分析指出，第一、台湾的医师太卖力了，不少医师一天至少看120个病人（美国平均约30个），这在全世界是绝无仅有的。其次，台湾医事辅助人员，医师除外，如护理人员、物理治疗师、营养师、心理复建师、药剂师等，用的人数相对少，薪水偏低，以护士为例，台湾护士薪水约美国的五分之一。第三、台湾医疗纠纷频率不高，医病关系很少诉讼，即便打官司，医师若败诉，赔偿金额也不高，误诊致死者，顶多赔一百到二百万台币，甚至一百万以下。第四、在美国医疗事业都是上市公司，盈亏压力大，台湾医疗事业不准上市，绝大部分是公营，有政府补贴。
相较之下，加拿大健保就没有这些优点。沈富雄指出，主要是加拿大没有效率，病人如要开一个不紧急的刀，如大腿髋关节手术，至少要排六个月以上；台湾如要开同样手术，一个礼拜就搞定。
沈富雄透露，几年前香港一度考虑采用台湾的健保制度，萧庆伦曾赴港解说，他也受到咨询实地赴港考察，最后他建议不要，港府也接受他的说法，“我觉得不要是对的。”因为这个制度只有在台湾才会成功，搬到全世界都会失败，“这是台湾特殊情况下产生开花结果的东西”。
香港制度介于台美之间
沈富雄表示，香港不适合效法台湾健保的原因，包括“香港医生没有台湾卖力、辅助医事人员比台湾多、薪水比台湾高、医疗纠纷比台湾多。”他说，香港制度介乎台湾与美国之间，美国的坏处它都有，没有美国严重，台湾的优点香港没有，例如台湾的医生勤苦耐劳、台湾医疗纠纷赔的不多，医疗事业没有上市等。
沈富雄并批评克鲁曼是个外行人，克鲁曼虽然是自由派，但心中有社会主义的色彩，所以他不完全排除政府的干预，但台湾健保是单一的提供者，比较听从单一的政府体系，而不是众多保险，而是单一保险，单一保险就是政府的角色。他只看到台湾健保的美，却没有看到内在的隐忧，因为台湾健保奠基在会崩盘的架构上，这就是要改革的原因。
政府每年健保支出近四千亿台币，但医疗专家批评每年医疗浪费达百亿元，导致健保年年亏损。沈富雄指出，健保的隐忧在于“我们收的钱的成长率不如开销的成长率”，所以每次拉成平衡，三年后就不平衡了。换言之，支出永远大于收入，因为没有节制，“没有自由市场的精神在里头。”台湾人喜欢逛医院，一个小感冒也要到大医院；有的妈妈早上带小孩看内科，如果病情未明显改善，下午再去看耳鼻喉科，在美国几乎是不可能的。
健保开销之所以居高不下有一个很重要因素是台湾人有吃药的习惯。去年一年健保药费支出达1250亿台币，较前年成长6.9%，其中台湾人吃最多的是治疗高血压、高血糖和高血脂的药物，去年吃掉323亿台币；十大健保药物排名第一的是具有降血压与保护心脏功效的“脉优”，已蝉联八年冠军宝座，一年就吃掉44亿 862万元。
台湾健保肩负着全民健康的使命，虽然官方宣称民众的满意度高达七成，却无法摆脱亏损的隐忧，如医疗资源有限、健保支出已超过保费收入等，不禁令识者忧心台湾健保究竟还可以撑多久。
台湾健保有可取之处，但不能光看它外表的花朵美丽而全盘移植，必须深入研究其特殊性，截长补短，方能避免亏损，促进全民健康。
新华网消息最新一期亚洲周刊发表童清峰的文章指出，台湾健保制度被认为是全球典范，从医疗需求、医疗供给等项目，都获称赞，在国际排名第二，仅次于瑞典，其中主要的原因是医生卖力、医护人员薪水低、医疗纠纷少及赔偿有限，还有医疗事业大部分公营，便于政府控制。
报道说，去年诺贝尔经济学奖得主、美国普林斯顿大学经济系教授兼《纽约时报》专栏作家克鲁曼（Paul Krugman），曾于《纽约时报》专栏大赞台湾健保制度，要美国人效法。
克鲁曼认为，台湾健保制度可“提供美国全民在经济上纳保的范例”。强调短短的六年间，台湾人民的健保纳保率快速成长，从不到六成冲到九成七。而且“台湾全民纳保的成本很低，考量人口增加和收入成长，就算整体医疗费用有任何成长，也不多”。
台湾健保制度于1995年3月1日正式实施，是国民党时代连战担任“阁揆”时最亮丽的政绩，它以被保险人口投保率高、投保费率低、给付范围广及就医方便而闻名于国际。台湾健保统合工劳农保医疗给付，建立单一体制的全民健康保险，采行单一支付管道，实施总额支付制度。
全民健保具有社会保险的精神，即所谓风险分摊，在自助互助的基本理念下，年轻人赚钱分担老幼的医疗风险，达到年龄族群和世代互助，而且形成庞大健康资料库，便利卫生研究工作；而行政费用维持在百分之二以下，因而极受国际推崇。
《经济学人信息部》（EIU）在2000年就医疗需求、医疗供给等项目，将台湾医疗保健评为世界第二，仅次瑞典。美国广播公司在 2003年制作节目盛赞台湾的健保，指出每人每月平均付20美元的保费，每次看诊平均付挂号费4到10美元，就可以到特约医院找任何医师看病。近年来，来台湾取经的国家不下50个。
台湾健保堪称价廉物美，民众根据薪资多寡，每月只要付少少的钱，即可享受到各样的医疗服务，不论贫富贵贱，去大医院或小诊所，所受到的医疗服务全都一样，一视同仁，有钱人纵使想多付钱获取额外服务，也不被允许；而且就医便利，医院、诊所到处都是，自己可以选择要在哪里就诊，无须医师指定。
健保不是被保险者付费而已，企业和政府也都要分摊，台湾公司行号有替员工加劳保就一定要替员工加健保，因为两者的加保金额都是以劳保加保金额为依据，且健保是跟着劳保走。现行法令规定雇主每月为员工负担之健保费为六成，员工与眷属自付三成，政府负担一成。
台湾健保投保金额采取分级制，根据薪资等级分为十组，例如月薪最低在1万7280元（约合500美元）以下者，每月缴纳600元；月薪最高13万1700者，每月缴5400元。
外劳也被纳入健保
由于全民健保是强制性保险，无论何人都必须参加健保，包括留学生、移民者，甚至外劳等都纳入。它主要的精神是“大病看大医院，小病看诊所”，任何人看病，除了支付挂号费外，病人还须分摊部分的医疗费用。
前民进党“立委”沈富雄前年在台大医院动了心导管手术，住院四天，装了一枝血管支架，他只付了新台币近2万元，健保帮他付了几十万，若无健保，同样的手术得花费一百多万元。
台湾健保“太便宜了”
医师出身的沈富雄，是当年“立法院”中少数被公认对健保下过工夫研究者，他指出，台湾每个人所缴的健保费大概是美国的六分之一到八分之一，“太便宜了”。
台湾健保是哈佛教授萧庆伦的构想，这个构想是参考加拿大单一保险人制度，但加拿大的健保基本上是失败的，为什么台湾能成功？沈富雄分析指出，第一、台湾的医师太卖力了，不少医师一天至少看120个病人（美国平均约30个），这在全世界是绝无仅有的。其次，台湾医事辅助人员，医师除外，如护理人员、物理治疗师、营养师、心理复建师、药剂师等，用的人数相对少，薪水偏低，以护士为例，台湾护士薪水约美国的五分之一。第三、台湾医疗纠纷频率不高，医病关系很少诉讼，即便打官司，医师若败诉，赔偿金额也不高，误诊致死者，顶多赔一百到二百万台币，甚至一百万以下。第四、在美国医疗事业都是上市公司，盈亏压力大，台湾医疗事业不准上市，绝大部分是公营，有政府补贴。
相较之下，加拿大健保就没有这些优点。沈富雄指出，主要是加拿大没有效率，病人如要开一个不紧急的刀，如大腿髋关节手术，至少要排六个月以上；台湾如要开同样手术，一个礼拜就搞定。
沈富雄透露，几年前香港一度考虑采用台湾的健保制度，萧庆伦曾赴港解说，他也受到咨询实地赴港考察，最后他建议不要，港府也接受他的说法，“我觉得不要是对的。”因为这个制度只有在台湾才会成功，搬到全世界都会失败，“这是台湾特殊情况下产生开花结果的东西”。
香港制度介于台美之间
沈富雄表示，香港不适合效法台湾健保的原因，包括“香港医生没有台湾卖力、辅助医事人员比台湾多、薪水比台湾高、医疗纠纷比台湾多。”他说，香港制度介乎台湾与美国之间，美国的坏处它都有，没有美国严重，台湾的优点香港没有，例如台湾的医生勤苦耐劳、台湾医疗纠纷赔的不多，医疗事业没有上市等。
沈富雄并批评克鲁曼是个外行人，克鲁曼虽然是自由派，但心中有社会主义的色彩，所以他不完全排除政府的干预，但台湾健保是单一的提供者，比较听从单一的政府体系，而不是众多保险，而是单一保险，单一保险就是政府的角色。他只看到台湾健保的美，却没有看到内在的隐忧，因为台湾健保奠基在会崩盘的架构上，这就是要改革的原因。
政府每年健保支出近四千亿台币，但医疗专家批评每年医疗浪费达百亿元，导致健保年年亏损。沈富雄指出，健保的隐忧在于“我们收的钱的成长率不如开销的成长率”，所以每次拉成平衡，三年后就不平衡了。换言之，支出永远大于收入，因为没有节制，“没有自由市场的精神在里头。”台湾人喜欢逛医院，一个小感冒也要到大医院；有的妈妈早上带小孩看内科，如果病情未明显改善，下午再去看耳鼻喉科，在美国几乎是不可能的。
健保开销之所以居高不下有一个很重要因素是台湾人有吃药的习惯。去年一年健保药费支出达1250亿台币，较前年成长6.9%，其中台湾人吃最多的是治疗高血压、高血糖和高血脂的药物，去年吃掉323亿台币；十大健保药物排名第一的是具有降血压与保护心脏功效的“脉优”，已蝉联八年冠军宝座，一年就吃掉44亿 862万元。
台湾健保肩负着全民健康的使命，虽然官方宣称民众的满意度高达七成，却无法摆脱亏损的隐忧，如医疗资源有限、健保支出已超过保费收入等，不禁令识者忧心台湾健保究竟还可以撑多久。
台湾健保有可取之处，但不能光看它外表的花朵美丽而全盘移植，必须深入研究其特殊性，截长补短，方能避免亏损，促进全民健康。
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