Health Care Equity In Taiwan: How Are Medical Schools Educating Future Doctors?

Towards the end of the 20^thcentury, the island nation of Taiwan had substantial gaps in health insurance and close to 50% of the population had little or no access to healthcare. Today, close to 100% of Taiwan’s 23 million population enjoys almost free access to health care with no waiting lines, and National Health Insurance (NHI), a public insurance system administered by a single entity – the Bureau of National Health Insurance -- has a satisfaction rate of over 70% and is strongly supported across the political spectrum. The democratization of health care in Taiwan, the result of a decades-long process culminating in 1995 with the passage of NIH, contributed significantly to health equity by reducing utilization rate differences and morbidity and mortality differences for conditions preventable through the administration of medical care. However, no efforts were made to change the training or societal role of physicians to produce a professional type better suited to the new model of health care premised on egalitarian principles. Curricular changes are currently underway to overcome these deficiencies and strengthen medical students’ grounding in humanistic principles. Whether these changes are also educating future physicians in an ethic of service that prepares them to contribute to Taiwan’s commitment to health care equity is unclear. The goal of this pilot exploratory study is to understand how the medical school curriculum contributes to the good ‘fit’ of future medical professionals with an egalitarian system of care and to identify challenges to this fit. We explore what motivates students to pursue a career in medicine, how medical education shapes their initial motivation, and how consistent are their evolving goals and professional identities with Taiwan’s conception of health care as a right. Our presentation discusses preliminary results of this ongoing investigation.