Progress Report Oral

1
Progress Report ( Oral)
Speaker Chien-Jen Chen, Minister of Health Date
February 25, 2004/7/13
2
Introduction
Creating a healthier living environment Ensuring
the quality of healthcare services
3
Policy Achievements

• Prevention and control of SARS, influenza and
  major infectious diseases
• Sustainable development of the National Health
  Insurance system
• Implementation of comprehensive medical care
• Development of special healthcare service
• Insurance of food and drug safety
• Strengthening of public health education and
  health promotion
• Promotion of technical development and
  international exchanges

4
Prevention and Control of SARS, Influenza and
Other Major Infectious Diseases
5
Ensuring the Effectiveness of SARS Prevention and
Control (1)

• Establishing a mobilization system for the
  prevention and control of SARS
• Setting up a fever monitoring and warning system
• Managing SARS case reporting and epidemiological
  surveys
• Strengthening of immigration screening,
  self-health management and house quarantine
  procedures
• Establishing management and distribution systems
  for disease control materials (protective
  clothing, N-95 surgical masks, flat face masks)
• Initiating a infectious disease prevention and
  control medical care network
• Creating a platform for international cooperation
  and opening communication channels

6
Ensuring the Effectiveness of SARS Prevention and
Control (2)

• Strengthening lab testing and protective
  procedures
• In response to an incident of SARS infection in a
  testing lab, sterilization measures were
  strengthened at 10 labs contracted to carry out
  SARS testing.
• A lab biosafety assessment committee and an
  inspection team for biosafety level 3 and level 4
  labs were established to strengthen inspection
  and management of lab safety.
• P3 and P4 labs were temporarily closed, and a
  series of training courses was held to ensure
  that lab personnel are well versed in standard
  lab procedures.
• WHO experts were invited to Taiwan to inspect six
  P2, P3 and P4 labs in early January 2004, and
  improvements were made in accordance with their
  suggestions.
• Arrangements have been made for a second round of
  inspections, with the WHO experts to be joined
  this time by experts from the US CDC and Japans
  National Infectious Disease Research Laboratory.
  These experts will conduct onsite inspections of
  the above labs, which will be reopened after
  their safety has been verified (it is predicted
  that they will reopen in mid-March 2004).

7
Implementing Infectious Disease Prevention and
Control

• Dengue fever prevention and controlWith the
  implementation of the 4-year Dengue Fever
  Prevention and Treatment Plan, local dengue fever
  cases fell from over 5,000 in 2002 to 86 in 2003.
• Enterovirus prevention and controlMonitoring and
  health education was stepped up to reduce deaths
  among serious cases.
• AIDS prevention and controlContinued efforts
  were made to strengthen health education and
  increase screening among high-risk groups. The
  rate of increase for HIV infection dropped from
  18 in 2002 to 9 in 2003.
• Tuberculosis prevention and controlTB monitoring
  and testing capabilities were strengthened, a
  case follow-up management system was implemented,
  and reporting time was reduced from 44 days to
  1.7 days. Moreover, the sputum testing rate rose
  from 75 to 93, and the age-standardized
  treatment rate for rose to 84.66.

8
Influenza and Avian Flu Prevention and Control
(1)

• With the expansion of influenza immunization
  programs for the elderly, the 65-and-over
  immunization rate rose to 69.1. The immunization
  rate for medical personnel was 92.1
• Monitoring of flue-like cases
• Influenza case monitoring in the Taiwan Area
  began in 1999. The most prevalent system is
  reporting of cases by sentinel doctors who base
  their diagnoses on sentinel symptoms with no
  testing involved.
• At present, over 500 clinic doctors are
  voluntarily participating in the case reporting
  system During the most recent week (the fifth
  week of 2004), the average number of cases
  reported per doctor was 29.0.
• There was a rise in cases during the last flu
  season, starting in late November 2002. After
  reaching a peak in January 2003, the number of
  cases gradually began to fall. Most recently,
  cases began to increase again in late November
  2003, but numbers were lower than in previous
  years.

9
Influenza and Avian Flu Prevention and Control
(2)

• Influenza vaccines were allocated to major
  poultry producing counties in the south for use
  in immunizing poultry workers.
• Health bureaus nationwide implemented health
  education programs for poultry workers.
• The antiviral medication Tamiflu was purchased
  and stockpiled for use in large-scale flu
  epidemics. This medication will be made available
  as needed depending on epidemic conditions.
• Educational materials on avian flu such as
  leaflets, VHS tapes and cassette tapes were
  produced for distribution to television, radio
  and print media, the general public, and incoming
  and outgoing travelers. Relevant information was
  also made available on the Center for Disease
  Control website for downloading by the general
  public.
• A plan was implemented to encourage the
  establishment of private-sector vaccine producers.

10
Promoting Sustainable Development of the National
Health Insurance System
11
Caring for Disadvantaged Groups, Closing the
Health Gap

• With the implementation of policies to protect
  the disadvantaged, the lower ones income, the
  higher ones NHI benefit/payment ratio.
• With the amendment of the National Health
  Insurance Act, NHI premium relief was provided to
  70,000 individuals.
• NHI self-payment premiums were waived for 31
  major illnesses and injuries, benefiting 640,000
  individuals.
• An integrated delivery service (IDS) for
  healthcare payments was implemented in 48
  townships in mountain regions, providing
  subsidies of NT 2.1 billion for 3 million
  medical visits.

12
Family Sector NHI Benefits and Expenditures per
Person2002 data
13
NHI Premium Subsidies and Assistance Measures for
Disadvantaged Groups

• 1. Premium subsidies
• Partial or full premium subsidies were
  provided to low-income households, middle and low
  income senior citizens 70 and over, the mentally
  or physically disabled, aborigines 20 and under
  and 55 and over, unemployed workers and 9/21
  Earthquake victims. In 2003, NT 5.7 billion in
  subsidies were provided to 990,000 people.
• 2. Healthcare safeguard measures for
  disadvantaged groups
• Relief loans In 2003, 24,000 loans were
  provided, totaling NT 1.45 billion.
• Premium payment by installments In 2003, 24,000
  installment arrangements were made, covering a
  total of NT 2.92 billion.
• Referral to social welfare organizations In
  2003, over 500 successful referrals were made,
  covering approximately NT 6 million.
• Healthcare safeguard measures In 2003,
  approximately 2,000 assistance applications were
  processed, covering approximately NT 26 million.
  
• 3. On June 18, 2003, the National Health
  Insurance Act was revised by presidential order
  to include a health insurance relief article to
  assist the economically disadvantaged in solving
  insurance coverage and medical care problems.

14
Handling Delinquent Payments from Local
Governments

• Article 30, Paragraph 5 of the revised National
  Health Insurance Act states that any government
  entity that does not make subsidy payments by the
  required deadline shall be charged interest on a
  daily basis, and shall be dealt with in
  accordance with compulsory enforcement
  regulations.
• All delinquent county and city governments aside
  from the Taipei and Kaohsiung city governments
  have presented payment plans.
• On January 13, 2004, the debts of the Taipei and
  Kaohsiung city governments were turned over to
  the courts for compulsory enforcement.
• Local government delinquent payments
• As of the end of 2003, NT 3.95 billion was
  recovered.
• Outstanding payments total 36.731 billion.

15
Safeguarding Patient Safety, Improving Healthcare
Quality

• 1. A pilot program to increase medical
  payments for the five major diseases
• (cervical cancer, breast cancer,
  tuberculosis, diabetes, asthma) was
• implemented.
• Over 1.22 million patients have benefited from
  this program.
• 2. A pilot program for the NHI family doctor
  integrated care system was
• implemented.
• As of January 2004, 24 such programs were
  underway in 15 counties and cities.
• 3. The revised National Health Insurance
  Payment Schedules went into effect.
• It is estimated that this latest revision to
  payment schedules will result in an increase of 3
  billion payment points.
• 4. Improved NHI drug coverage
• The range of drugs covered by the National Health
  Insurance is being gradually expanded
• Drug treatment for hepatitis B and C is now
  covered.

16
NHI IC Card Implementation Progress

• Starting from January 2004, the National Health
  Insurance IC card went into full effect.
• Implementation principles making medical care
  available to all, eliminating reimbursement risks
  for hospitals and clinics.
• Since implementation, NHI IC card operations have
  run smoothly.
• Supporting measures for exceptions to NHI IC card
  use
• Individuals who have not yet obtained their IC
  cards have only to sign the Treatment Exception
  Register to receive treatment under the National
  Health Insurance system.
• The small number of clinics that have yet to
  receive guidance in joining the NHI IC card
  system may apply for an exception to continue
  practicing.

17
Supporting Measures for the 2004 Hospital Budget
Global Payment System

• Review of reasonable hospital outpatient loads,
  implementation of treatment categories
• Continued promotion of payment schedule reform,
  improvement of critical care
• Promotion of chronic illness prescriptions,
  reduction of redundant medical care
• Strengthening of resource waste control
  mechanisms, promoting rational use of health
  insurance resources
• Continued review of the soundness of
  inpatient/outpatient ratios set by hospitals
• Promotion of hospital excellence plans and
  reshaping of hospital functions to ensure that
  hospitals fulfill the roles expected by society
• Enabling co-management and ensuring that
  information and feedback are provided in a timely
  manner
• Timely implementation of the hospital global
  budget specialized autonomous proxy system in
  accordance with administrative procedure law and
  government procurement law, thus encouraging the
  co-management of expenses

18
National Health Insurance Satisfaction
Survey(4/20/1995 12/19/2003)
19
In an article published in the May 2003 issue of
the prestigious journal Health Affairs, the
Princeton scholar Tsung-Mei Cheng praised
Taiwans National Health Insurance system as an
outstanding achievement, emphasizing its
following strengths
National Health Insurance Results

• Universal coverage
• A consistent approval rating of approximately 70
• Comprehensive coverage range
• Highly accessible treatment
• Appropriate total medical expense control
• Low costs and high care standards in comparison
  to other countries

20
Implementing Comprehensive Medical Care
21
Healthcare Resource Growth Status
(2003 target successfully met)
(2003 target successfully met)
Notes 1. This is a four-year project, with
measures and targets set in 2001. 2. The numbers
listed on this chart are for approved, in-use
beds. 3. 2003 targets for Western doctors and
critical beds were successfully met.
22
Medical Personnel Training and Planning General
Medical Training Program for Medical School
Graduates

• Providing training in the areas of whole-person
  healthcare, medical ethics, evidence-based
  medicine, and infection control 1,427 doctors at
  94 hospitals have participated in this program.
• Providing four levels of general medical training
  in a mentor training program 95 people have
  completed this training.

23
Ensuring the Quality of Healthcare Services

• 1. Establishing a medical care environment that
  emphasizes patient safety
• A patient safety committee was established in
  February 2003.
• Safety education training classes were held for
  over 20 types of medical personnel. Over 3,000
  people attended these courses.
• The Clinic Safety Procedure Reference Guide was
  promulgated on October 23, 2003.
• 2. Assessment standards, assessment forms and
  information forms for the various categories of
  hospitals were revised.
• 3. Crating a more sound Chinese medicine clinical
  education environment
• Seven Chinese medicine clinical education centers
  were established.
• Field investigations of 33 Chinese medicine
  hospitals and Chinese medicine hospital
  departments were carried out.

24
DOH-affiliated Hospitals

• 1. Among the total of 34 DOH-affiliated
  hospitals, there are 21 general hospitals, 6
  branch hospitals, 5 psychiatric hospitals, 1
  leprosy hospital and 1 thoracic hospital.
• 2. Operational efficiency was much greater in
  2002 than in 1999 (the year the new system was
  implemented)

Note Because the final accounts for 2003 were
not yet complete, figures from monthly accounting
reports were used.
25
Development of Health and Medical Information (1)

• The Health Information Network was enhanced by
  upgrading dialup Internet connections at
  nongovernmental hospitals and clinics to ISDN
  64K. At present, an average of 1,300
  nongovernmental hospitals and clinics use this
  type of connection every month.
• Network intrusion detection systems were
  installed at 30 DOH-affiliated hospitals to
  detect hacker activity and protect networks from
  hacker attacks.
• Teleconferencing systems have been set up at 73
  health organizations, including county and city
  health bureaus, DOH-affiliated hospitals and
  designated SARS treatment hospitals, facilitating
  inter-organizational meetings.
• A DOH medical information storage system with
  statistical analysis and trend forecasting
  capabilities was established.
• The DOH developed and implemented an online
  application system covering 52 service items in
  such areas as medical affairs, pharmaceutical
  affairs and food sanitation, making it possible
  for the public to complete applications online,
  download forms and keep track of application
  status.

26
Development of Health and Medical Information (2)

• Since its establishment, the Medical Care
  Certification Management Center has issued 45,000
  healthcare certification IC cards for use in
  electronic medical records, the Electronic
  Medical Record Index Center, birth reporting, and
  electronic document exchange systems.
• 120 hospitals and clinics were chosen to
  participate in a program to promote the use of
  electronic medical records. To date,
  approximately 5,000 electronic files have been
  exchanged in 2,150 exchange sessions.
• With the establishment of the Electronic Medical
  Record Index Center, patients will be able to
  gain access to their past medical records after
  presenting their NHI IC cards to medical
  personnel for verification. This system is now
  being brought online 195,661 entries have been
  added, and 964 entries have been accessed.
• The Drug Interaction Database has been developed
  to enable hospitals, clinics and pharmacies to
  look up and download drug interaction
  information. During the testing stage, the
  Database has so far received 1,086 hits.
• The Medical Care Resource Management and
  Geographical Distribution Information System has
  been developed to provide quick access to medical
  care resource distribution and usage information
  as an aid in decision-making. Plans are currently
  underway to provide education and training in the
  use of this system.
• A preliminary announcement has been made about
  the Electronic Medical Record HL7/XML Referral
  and Proxy Testing Protocol, which will provide a
  standard for inter-hospital exchange of
  electronic medical records.

27
Developing Special Healthcare Services
28
Strengthening Medical Rescue and Response
Mechanisms

• Eight hospitals were designated as poison and
  chemical emergency hospitals 23 hospitals added
  contamination control and protective equipment
  antidote reserves were created at 47 hospitals
  nationwide and four hospitals were designated as
  poison information and testing centers.
• Seven hospitals were designated as nuclear
  disaster level 2 emergency hospitals, and six
  hospitals were designated as nuclear disaster
  level 3 emergency hospitals.

29
Strengthening the National Mental Health System
1. Expanding psychiatric manpower and facilities
2. In order to implement the post-SARS
revitalization of the mental health system, 72
hospitals and county/city mental health centers
were chosen to provide mental rehabilitation
services. As of the end of 2003, such services
had been provided to 128 SARS patients, 158 house
quarantine patients and 9 family members of SARS
patients.
30
Developing Sound Long-term Care Services and
Rehabilitation for the Mentally and Physically
Disabled
Enhancing medical care resources for the elderly,
long-term care and childrens early intervention
31
Improving Healthcare Facilities in Mountain
Regions, Offshore Islands, and Aboriginal Areas

• A healthcare equipment guide for mountain regions
  and offshore islands was created.
• 715 subsidies have been provided to health
  departments in mountain regions and offshore
  islands for the purchase of emergency medical
  equipment the facilities at 26 health stations
  in mountain regions and 6 in the offshore islands
  have been upgraded.
• Community health promotion plans have been
  implemented in mountain regions, outlying
  islands, and aboriginal areas. As of the present,
  58 community health building centers had been
  established.

32
Ensuring Food and Drug Safety
33
Creating a Sound New Drug RD Environment

• To establish a clinical research environment and
  spur development in the biotech sector, six
  clinical trial centers for Western drugs and nine
  clinical trial centers for Chinese medicine have
  been established.
• Inspections conducted at the various Chinese
  medicine clinical trial centers showed that all
  of the centers are capable of independently
  conducting testing in accordance with GCP
  standards.
• The Taiwan Chinese Herbal Medicine Clinical Trial
  Environment and Testing Regulations were
  published.
• Chinese medicine clinical trial personnel
  training courses were held, with 1,052 people
  attending.
• 137 new drug RD counseling and guidance sessions
  were held for pharmaceutical manufacturers.
• Establishing an adverse drug reaction reporting
  system
• As of December 2003, 6,410 cases of adverse
  reactions to on-the-market drugs were reported.

34
Simplifying the new drug approval system

• The approval process has been shortened to
  approximately 80 days .
• An Approval Time Comparison between Taiwan and
  Other Countries (2002)

35
Strengthening Safety Management for Chinese
Medicine

• The use of five Chinese medicine materials
  containing aristolochic acid (fangchi root,
  aristolochia root, Manchurian dutchmanspipe stem,
  dutchmanspipe fruit and dutchmanspipe vine), as
  well as products containing these materials was
  prohibited, and 50 related permits were
  cancelled.
• Completion of the Dictionary of Chinese
  Pharmacopia Medicine (draft form) was announced.
• Heavy metal standards for eucommia bark and six
  other Chinese medicine materials (cadmium
  lead

36
Creating GMP Management Mechanisms for Drugs

• 1. Local
• In 2003, follow-up inspections of 101 GMP
  pharmaceutical factories were carried out.
• Promoting cGMP standards In 2003, 124 factories
  passed the second stage of the validation
  process, and 4 passed the third stage. ?
• 2. Foreign
• First stage validation for foreign pharmaceutical
  manufacturers 826 evaluations were conducted in
  2003.
• GMP evaluations of foreign pharmaceutical
  manufacturers 2 evaluations were carried out in
  2003.

37
Raising Health Bureau Food and Drug Testing
Standards

• In the interests of bringing the capabilities of
  testing labs at local health bureaus up to
  international standards, in 2003 42,856 food
  tests were carried out at health bureaus across
  the country. These tests were divided into 12
  categories, including chemical additives and
  microbes.
• Guidance was provided to health bureaus in
  applying for Chinese National Laboratory
  Accreditation. Nine health bureaus received CNLA
  accreditation in 2003, and 18 health bureaus have
  received accreditation to date.

38
Consumer Protection Risk Management

• 1. Promoting licensing for pharmacy personnel
• The licensing target for pharmacy personnel was
  raised from 20 to 80.
• 2. Promoting hospital and clinic drug labeling
• New drug labeling standards include 13 required
  items and 3 suggested items.
• These standards were initially implemented at 18
  hospitals, and later at 40 more hospitals and
  clinics, and 400 community pharmacies, for a
  total of 20 million labels.
• 3. Promoting the comprehensive development of
  community pharmacy services
• In the spring semester of 2003, 51 drug
  information courses were held at 50 community
  colleges, with a total attendance of 1,983.
• The DOH advocated the establishment of community
  pharmacies to meet the needs of families in each
  neighborhood.
• 4. Policing of false advertising 1,777 drug
  advertising violations, 1,184 food advertising
  violations, and 434 Chinese medicine advertising
  violations were uncovered.

39
Controlled Drug Management

• Implementing a controlled drug licensing system
• Amendments were made to controlled drug
  management regulations.
• Organization and enterprise registration
  management By the end of 2003, 11,659
  registrations had been issued to organizations
  and enterprises, and registrations for 31,332
  individual users were being managed.
• The average waiting period for issuing of
  controlled drug permits dropped from 4.6 days in
  2002 to 4 days.
• Strengthening controlled drug inspection and
  control Online filing of controlled drug revenue
  and expenditure figures was implemented.
• Strengthening substance abuse management
• 13 drug testing organizations have received
  approval to conduct urine drug tests.
• A total of 2,130 samples were sent for drug
  testing.
• Enhancing the Controlled Substance Abuse
  Reporting Information System 96 medical care
  institutions were added to the list of reporting
  units.

40
Ensuring Food Safety (1)

• Food manufacturer self management for sanitation
• 1. Encouraging sanitation self-management among
  manufacturers
• A food safety control system for the fishing
  product industry was announced.
• 2. Implementing GM food management
• 11 GM soybean and corn products underwent the
  inspection and registration process.
• 408 products underwent market monitoring and
  investigation.
• A GM foods website was established, and has
  received approximately 580,000 visitors.
• 3. Strengthening health food management
• 40 products received approval.
• A law amendment bill has been drafted, and is
  currently under review.

41
Ensuring Food Safety (2)

• Strengthening food sanitation
• Preventing food poisoning Guidance was provided
  to 171 take-out food enterprises (45 of a total
  382 take-out food enterprises) and 64 food and
  beverage service enterprises, a total of 235
  enterprises, in applying for preliminary
  certification under the food safety control
  system.
• Guidance and inspections for producers of Chinese
  New Year food products Out of the 433 producers
  subjected to inspection, 6 were found to be in
  violation of sanitation standards. These
  producers all met the compliance deadlines eight
  products were spot checked, and were all found to
  be up to standard.
• Promoting a nutrition labeling system
• Nutrition labeling will be implemented in stages
  for the following food product categories dairy
  products, cooking oil, frozen foods, baked goods,
  grain products, canned goods, and candy. 23
  instruction sessions have been held for
  manufacturers.
• Inspecting food products on the market has become
  part of regular health bureau operations.

42
Strengthening Health Education and Health
Promoting
43
Promoting National Health (1)

• 1. Prevention and control of major diseases
• In the interests of actively promoting cancer
  prevention and control, the Cancer Act was passed
  on May 21, 2003.
• The three-year pap smear rate for women 30 and
  over has risen to 53.5.
• The standardized cervical cancer death rate fell
  from 7.0/10,000 people in 1991 to 4.9/10,000
  people in 2002.
• 160,000 women aged 50 and over have undergone
  breast cancer screening, and 190,000 betel nut
  users have undergone oral cavity cancer
  screening.
• Promoting hypertension and diabetes prevention
  and control, and pilot programs for stroke,
  asthma and kidney disease
• 17counties and cities have implemented
  comprehensive preventative healthcare services,
  raising the adult testing utilization rate to
  40.
• A coverage rate of 89 was achieved for diabetes
  shared care programs, and 240 diabetes support
  groups were established.
• 188 health promotion organizations for asthma and
  other diseases were established.
• 2. Promoting comprehensive tobacco hazard control
  measures
• Creating a smoke-free environment 175 schools,
  770 restaurants and 160 workplaces are now
  smoke-free.
• Providing quit-smoking services Assistance has
  been provided to 33,227 people, and a six-month
  smoking cessation rate of 24.8 has been
  achieved.
• Strengthening law enforcement In 2003, 495,614
  inspections were made, and 28,363 violations were
  recorded since the Tobacco Hazard Violation
  Complaint and Processing Center was established,
  425 complaints have been received.

44
Promoting National Health (2)

• 3. Building healthy communities
• 256 community health building centers have been
  established, as well as four healthy communities
  that meet WHO standards.
• Plans to create healthy environments and living
  spaces have been implemented in 31 communities.
• 4. Safeguarding womens and childrens health
• A nationwide genetic health service network was
  established to provide care for newborns with
  rare diseases.
• The newborn inherited metabolic disorders
  screening rate has risen to 99.8, and
  abnormalities have been detected in 3,468
  newborns.
• In the interests of providing better care for
  foreign spouses and their children, healthcare
  manuals have been produced in four foreign
  languages.
• Creating an environment more conducive to
  breastfeeding
• In 2003, 74 medical care institutions received
  mother-and-infant-friendly certification.
• The birth-to-one-month breastfeeding rate at
  these institutions rose to 75.05
• With the promulgation of the Oral Health Act in
  May 2003, active steps have been taken to promote
  oral health
• 1,830,000 children have benefited from a
  program to provide anti-cavity fluoride mouthwash
  at primary schools, a penetration rate of 98.

45
Promoting National Health (3)

• 5. Strengthening nutrition education
• In coordination with the Challenge 1,824 plan,
  385 registration booths were set up, and 3,903
  educational events were held, with an overall
  attendance of 470,350.
• 200 food and beverage enterprises participated in
  this seasons program to promote healthy diets, a
  9.3 increase over last seasons 183 enterprises.
• To enhance health education, information about
  the nutrition labeling system was made available
  online.

46
Promoting National Health (4)

• 6. Establishing a model for health promotion
  schools
• The DOH cooperated with the education sector to
  produce a health promotion school guide, and
  coordinated with the Ministry of Education to
  make health promotion schools a policy priority
  in 2003.
• An international symposium on health promotion
  schools was held, with 13 experts from the US, UK
  and Germany attending. Participants included
  personnel from county and city health bureaus,
  education departments and schools.
• A teachers health education information platform
  was established, and this information was
  combined with 1-9 grade health and physical
  education teaching materials to create an online
  resource website. As of January 31, 2004, this
  website had received 120,000 visits.

47
Promoting National Health (5)

• 7. Implementing youth health education
• Training youth volunteers to provide service in
  schools and communities In 2003, 87 health
  ambassador teams were trained, and 957 volunteers
  performed health service work. Services were
  provided to 87,900 people.
• Drug abuse prevention training was held at
  teachers colleges. 96.3 of participants felt
  that the knowledge provided would be useful in
  drug abuse prevention.

48
Establishing an Effective Health Education Model

• Promoting diversified health education
• The Health 99, Health Education Resource Center,
  and Youth Health websites were brought online.
• A variety of health education activities were
  held to raise public awareness of health issues.
• Community, school, and medical care institutions
  resources were used to educate the public on
  health issues.
• Developing an integrated model for health
  education media
• In 2003, 17,923 television time slots, 13,410
  radio time slots, 56 outdoor advertisements
  (light box signs, bus advertisements), 282 print
  media advertisements (newspapers, magazines), and
  31 Internet advertisements (including cell phone
  ads) were centrally purchased, thus saving nearly
  57 in advertising costs.
• A flexible communication model was established to
  respond to emergency needs. During the SARS
  outbreak, media and advertising channels
  nationwide were rapidly mobilized, and the
  efforts of the various government bodies were
  coordinated, thus making it possible to
  disseminate comprehensive SARS information.
  According to a public opinion survey conducted by
  the Research, Development, and Evaluation
  Commission, the public approval rating for SARS
  prevention and treatment was 81.1.

49
Development Promoting Technological and
International Exchange
50
Technological Development (1)

• Enhancement of mid-term technology planning As
  part of seven national-level plans, 714
  technology research plans in such areas as
  medicine, drugs, food products and biotechnology
  were set into motion.
• A new research report archive search website was
  established to provide both the general public
  and researchers with quick and convenient search
  capabilities.
• Subsidies were provided for the holding of
  technology seminars both locally and abroad (113
  seminars were held, with attendance of over
  26,000).
• The National Health Policy Conference was
  convened, with proceedings to be used in the
  drafting of future health policy.

51
Technological Development (2)

• Cancer research Over 20 interdepartmental
  research projects have already been completed,
  and plans are underway for third-stage clinical
  trials of thalidomide and the breast caner drug
  Herceptin. In view of the high levels of liver
  cancer in Taiwan, a research study of
  post-operative treatment for liver cancer is
  currently being conducted. This study is the
  largest of its type in the world, and its results
  should be of great benefit in the post-operative
  rehabilitation of liver cancer patients.
• SARS research The current project to develop
  quick and effective testing methods can help
  reduce the numbers of both false-positive
  diagnoses and false-negative test results. The
  results of this project have already been
  accepted for publication in the journal, Clinical
  Infectious Disease.
• Genome Medicine research Genome sequencing teams
  from the National Yang Ming University, National
  Cheng Kung University and the Industrial
  Technology Research Institute worked together to
  successfully complete sequencing and analysis of
  the 5,280,000 base pairs of the Vibrio vulnificus
  bacterium. Their results, a first for Taiwanese
  researchers, have been published in the journal,
  Genome Research.

52
Technological Development (3)

• New drug RD Research has been undertaken to
  develop new drugs to fight enteroviruses,
  hepatitis C and SARS. An anti-enterovirus drug
  developed through this research has already
  received a US patent, and animal model testing is
  being planned. Clinical trials have begun on an
  anti-hepatitis C drug, and patent applications
  have been filed for an anti-SARS drug, which will
  soon begin clinical trials.
• Vaccine research The receptor binding sites on
  the SARS coronavirus S protein has been
  successfully determined. A US patent application
  has already been filed for these research
  findings.
• Biostatistics and bioinformatics research The
  National Health Survey Information Management
  Center has been established, and is cooperating
  with the Stanford University in conducting an
  international research project on hypertension
  and insulin genes in the Asia-Pacific region.
  This project has already progressed to studying
  the relationship between the disease and specific
  genes.
• The results of the 2001 Taiwan Area National
  Health Survey were made public, providing the
  various sectors with comprehensive and valuable
  national health information.

53
Technological Development (4)

• Research results and technology transfers
• Research papers From 2002 to the present, over
  251 papers have been published.

• Patents
• four patents were obtainedone in Taiwan and
  four in the US.
• 54 patents are in the application stage19 in
  Taiwan, 29 in the US and six in other
• countries
• Technology transfers six technology transfer
  agreements are in effect
• Industry-academic cooperation
• there were 17 industry-academic cooperation
  projects, 28 academic-research
• cooperation projects, and three international
  cooperation projects.

54
Promoting International Health Exchange

• At the Asia Pacific Economic Cooperation (APEC)
  Conference, the APEC Health Task Force (HTF) was
  promoted and established.
• Such international organizations as APEC, the
  Asian Development Bank (ADB), the Pan American
  Health Organization (PAHO), the European Health
  Forum in Gastein, and the West African Health
  Organization (WAHO) were used to promote
  bilateral talks and expand cooperation and
  exchange.
• Cooperation and aid programs in Central and South
  America, Africa, Asia and the Middle East in such
  areas as infectious disease prevention and
  control and the establishment of health
  information systems were actively promoted. A
  present, nine health cooperation and exchange
  programs are operating in seven countries, and
  medical and material aid programs are operating
  in four countries.
• A cooperation memorandum was signed with Japans
  National Institute of Infectious Disease.
  Bilateral or multilateral research data exchange
  or cooperation programs were established with the
  UKs Health Protective Agency (HEPA) and the EU
  6th Scientific Framework Programmes 6-country
  SARS Joint Research Team. In addition, channels
  for the ongoing exchange of epidemic data were
  established with the WHO, WPRO, APEC and the
  national health departments in the US, Singapore
  and Hong Kong.
• In the interests of strengthening cooperation
  with major international organizations, guidance
  was provided to help local NGOs participate in
  aid activities sponsored by international NGOs.
• Efforts were made to foster international health
  professionals.

55
Progress in Promoting WHO Membership

• The WHO passed the SARS Resolution, providing
  Taiwan with new points of contact.
• Taiwan has received increased support from the
  governments of many countries.
• International medical and health organizations
  have issued public statements of support.
• An international health cooperation plan was
  implemented.
• Prompt reporting on Taiwans efforts has appeared
  in the international media.
• A website about Taiwans WHO bid was established.

56
International Health Cooperation Plans
57
Future Prospects
Prospects for 2004 --
Cherishing Life, Investing in Health
58
Strengthening DOH Operations and Increasing
Service Efficiency (1)

• In order to strengthen quarantine, laboratory
  testing and disease monitoring functions, the
  organizational statutes of the Center for Disease
  Control will be revised.
• In the interests of getting more scholars,
  experts and infection control doctors involved in
  disease control, the personnel system will be
  made more flexible, and more opportunities for
  advancement will be opened up.
• A unified food and drug administration system
  will be established.

59
Strengthening DOH Operations and Increasing
Service Efficiency (2)

• The DOHs Bureau of Medical Affairs and the
  Central Taiwan Office will be transformed into
  the Bureau of Medicine and the Bureau of
  Healthcare Development, respectively. In the
  interests of strengthening international
  cooperation, a Bureau of International
  Cooperation and Representatives will be added. A
  Health Police unit will also be added to enhance
  inspection and seizure capabilities.
• At DOH-affiliated hospitals, regional alliance
  self-management arrangements are being expanded,
  management structures are being streamlined, and
  regulations are being examined and revised, which
  will result in annual reductions in personnel
  subsidies of 5-10.

60
Strengthening DOH Operations and Increasing
Service Efficiency (2)

• Reorganization of the National Health Insurance
  system At the end of June 2004, the Executive
  Yuans 2nd generation NHI planning committee will
  present its planning results. These results will
  be used as a reference in devising measures for
  reorganization of the Bureau of National Health
  Insurance and its related committees, and for
  planning an appropriate timetable and legal
  revisions.
• Mechanisms for interdepartmental cooperation on
  health issues (SARS, AIDS, suicide prevention,
  policing of false advertising, strengthening of
  sex education, better protections for
  disadvantaged groups) will be strengthened and
  expanded.

61
Cherishing Life, Placing Value on Preventive
Healthcare (1)

• Cherishing life was chosen as the central
  health education theme for 2004. Under this
  theme, the following areas are being emphasized
  health fitness, healthy diet, youth sex
  education, AIDS prevention and control, cancer
  prevention, and proper drug use, etc. Goals are
  as follows
• Achieving a 10 increase in the public acceptance
  rating of the DOHs health education messages.
• Expanding youth sex education promoting healthy
  relations between the sexes, achieving a sex rate
  of under 13.9 among high school students,
  promoting safe sex, achieving a birth control
  rate of 44 for first sexual intercourse.
• Raising six-month smoking cessation numbers to
  10,700 people.
• Achieving three-year pap smear numbers of
  3,330,000 among women 30 and over, or a pap smear
  rate of 54, and drafting the National Cancer
  Prevention and Control 5-year Plan.

62
Cherishing Life, Placing Value on Preventive
Healthcare (2)

• Strengthening suicide prevention efforts
• Plans are underway to establish a national
  suicide prevention center and strengthen
  community mental health education.
• There are also plans to establish an
  interdepartmental (Ministry of the Interior,
  Ministry of Education, Council of Labor Affairs,
  Department of Health, and Government Information
  Office) suicide prevention taskforce.
• Building healthy communities, protecting womens
  and childrens health
• Providing guidance to 20 communities in creating
  healthy environments and living spaces
• Designating 30 schools as health promotion
  schools
• Certifying 80 hospitals as mother and infant
  friendly
• Raising birth-to-one-month
  breastfeeding rates at these hospitals to 77
• (and raising the national
  birth-to-one-month breastfeeding rate to 52)
• Achieving penetration rate of 98.5 for
  anti-cavity fluoride mouthwash in primary schools
  nationwide

63
Cherishing Life, Placing Value on Preventive
Healthcare (3)

• 4. Preventing diseases
• Funds will be invested to strengthen breast
  cancer and cervical cancer screening (NT 450
  million and NT 800 million, respectively).
• Preventive dental care for children will be
  enhanced, and the number of preventive dental
  visits for children six and under will be
  increased from six to nine.
• 5. Preventing small illnesses from becoming major
  health problems NT 600 million will be invested
  in expanding the Family Medicine Integration
  Plan.
• 6. Preventing major illnesses from worsening
• The pilot program to increase medical payments
  for the five major diseases (cervical cancer,
  breast cancer, tuberculosis, diabetes, asthma)
  will be continued.
• This program will be expanded in 2004 to include
  schizophrenia, hypertension and early
  intervention.

64
Cherishing Life, Placing Value on Preventive
Healthcare (4)

• 7. Improving preventive healthcare Efforts will
  be made to increase NHI participation to nearly
  100.
• 8. Strengthening healthcare for Taiwanese
  businesspeople on mainland China
• In view of the special medical care needs of
  Taiwanese businesspeople in mainland China,
  attempts will be made to establish contracts with
  mainland hospitals for treatment of Taiwanese
  businesspeople and their dependants under the NHI
  system.
• In the future, the enhancement of medical care
  resources and construction of higher-level
  hospitals in the Kinmen-Matsu Area will provide
  more treatment options for Taiwanese
  businesspeople residing in the coastal areas of
  Fujian Province.
• 9. Reducing waste of healthcare resources The
  NHI IC card will be used to prevent inflated
  reporting of fees.

65
Freeing People from the Fear of Disease,
Establishing an Infectious Disease Medical Care
Network

• Improving the hospital infection control system
• At 22 designated hospitals, personnel will be
  provided with enhanced infection control
  training, and negative-pressure rooms and
  quarantine procedures will be established.
• NHI payment schedules will be revised, and an
  assessment and incentive scheme for infection
  control quality standards in hospitals and
  clinics will be implemented.
• Community fever monitoring will be strengthened,
  immigration screening measures will be enhanced,
  and an effective case follow-up system will be
  established.
• A medical care system for coping with SARS and
  other emerging and reemerging infectious diseases
  will be established.
• Lab equipment and testing capabilities and
  quality will be improved.
• An disease control materials management plan will
  be established.

66
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (1)

• 1. Establishing a hospital accreditation system
  that emphasizes care quality and community
  medicine
• The hospital accreditation system will be
  reformed to emphasize process and results rather
  than structure. Stress will be placed on patient
  safety, whole-person education and medical
  ethics, infection control, crisis management,
  prevention of medical errors, and guidance and
  protection of medical and nursing students.
• The 2004 hospital accreditation and teaching
  hospital accreditation procedures and standards
  have been announced, and 184 hospitals have
  applied.
• A regular but unscheduled accreditation
  follow-up system went into full effect, and will
  perform follow-ups on an estimated 120 hospitals.

67
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (2)

• 2. Implementing a general medical training
  program for medical school graduates
• The goal of this program will be to provide
  training in the areas of whole-person healthcare,
  medical ethics, evidence-based medicine and
  infection control.
• It is estimated that approximately 100 hospitals
  and 1,450 doctors will participate in this
  program.
• A mentor training program was also established
• 95 mentors were trained in 1993, and 150
  in 1994, a total of 245.
• 3. Promoting the pilot program for the NHI family
  doctor integrated care system
• It is estimated that in 2004 the program will be
  expanded to 200 locations.

68
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (3)

• 4. Establishing a medical care environment that
  emphasizes patient safety
• Creating a patient-oriented medical care
  environment
• In the interests of implementing safe operating
  standards in hospitals, hospital safety
  guidelines have been drafted.
• A medical error reporting system that does not
  emphasize punishment will be established.
• 5.Continued promotion of the Chinese medicine
  clinical teaching environment
• In 2004, two hospitals were commissioned to
  implement the Establishing an Integrated Chinese
  Medicine Clinical Teaching SystemChinese
  Medicine Hospitals plan, and nine hospitals were
  commissioned to implement the Establishing an
  Integrated Chinese Medicine Clinical Teaching
  SystemChinese Medical Consultation plan.

69
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(1)

• 1. Raising health bureau food and drug testing
  standards
• In 2004, guidance will be provided to four health
  bureaus in applying for Chinese National
  Laboratory Accreditation, bringing the total of
  accredited health bureaus to 22.
• 2. Promoting public knowledge of proper drug use
• The use of drug labels with 13 required items
  will be promoted and implemented at 15,000
  clinics and 6,000 pharmacies.
• A pharmacist licensing plan will be promoted.
• The Drug Identification Handbook (fourth edition,
  covering over 4,200 drugs) will be promoted, and
  5 million CD-ROM copies will be distributed.
• Classes on proper drug use will be taught to
  community college and sixth-grade students, with
  a 2004 target of 3,000 primary school students
  and 10,000 community college students.

70
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(2)

• 3. Strengthening drug abuse management
• Enhancing the Controlled Drug Abuse Reporting
  Information System
• It is predicted that in 2004 the number of
  reporting units will grow by 10 to a total of
  106.
• 4. Implementing Chinese medicine quality control
• Safe drug use in the field of Chinese medicine
  will be promoted.
• Chinese medicine producers will be coached in
  good manufacturing practices
• By the end of February 2005, guidance will be
  provided to at least ten producers of traditional
  Chinese medicine in implementing GMP systems.
• 5. Strengthening food and drug inspection and
  seizure capabilities.

71
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(3)

• 6. Ensuring food safety
• Guidance will be provided to 70 of fishing
  product in implementing HACCP systems.
• GM food labeling, monitoring and pre-market
  inspection systems will be implemented, and a GM
  food safety assessment system will be
  established.
• It is estimated that 235 restaurants will promote
  healthy meals on an ongoing basis, and that 245
  restaurants will obtain preliminary certification
  under the food safety control system.
• The DOH will continue promoting nutrition
  labeling and national health monitoring systems.

72
Cherishing Life, Investing in Health

• Drafting a Healthy Taiwan Development Plan
• Developing a community healthcare service network
• Developing a national healthcare information
  platform
• Developing a public health and epidemic disease
  service network
• Making Taiwans national health information and
  personnel more competitive
• Promoting the development of the healthcare
  industry and other related industries

73
Legislative Plan for the Current Session

• 1. Priority bills
• Department of Health, Executive Yuan
  Organizational Act amendment bill
• Center for Disease Control, Department of Health,
  Executive Yuan Organizational Statute amendment
  bill
• Tobacco Hazard Prevention Act amendment bill
• Pharmaceutical Affairs Act amendment bill
• Medical Care Act amendment bill
• Rare Disease Prevention and Orphan Drug Act
  amendment bill
• Nutritionist Law amendment bill
• Controlled Drug Management Statute amendment bill
• Operational Sanitation Management Act draft bill
• 2. Other related bills
• AIDS Prevention and Control Statute amendment
  bill
• Food and Drug Administration Act amendment bill

74
Summary Cherishing Life, Investing in Health

• Strengthening DOH operations and increasing
  service efficiency
• Cherishing life, placing value on preventive
  healthcare
• Freeing people from the fear of disease,
  establishing an infectious
• disease medical care network
• Emphasizing whole-person healthcare, enhancing
  care quality
• Establishing a unified food and drug
  administration system to protect
• public safety

75
We thank you sincerely for your support, and
respectfully request your advice