How over-prescribing and medical waste issues illustrate why the WHA needs Taiwan

Government data showing extent of Taiwan’s huge medical waste problem highlights how doctors here often act against global health standards


(By Wikimedia Commons)

TAIPEI (Taiwan News) —The extent of Taiwan’s pharmaceutical excess has been laid bare this week in data released by the Health and Welfare Department of the Ministry of National Health Insurance. And their revelations are a clear indication of why it is important that Taiwan is allowed to play a full part in global health policy development at events like the World Health Assembly (WHA).

The data related to pharmaceutical waste revealed that Taiwan is throwing away a staggering 193 metric tons of medicine every year. In trying to make that number comprehensible to the public, the CNA report said that if you laid all those pills side by side they would go round the coast of Taiwan eight times.

They also cited just one Taiwanese pharmacist who emptied his pharmacy’s medical recycling box and found NT$3.5 million worth of pills and asthma inhalers, many of which were unopened.

While a few departmental schemes to cut down on this waste were also mentioned, it is quite clear that they are barely scratching the surface of what is an endemic problem.

Minor policy changes are not going to get to the heart of what is an issue of Taiwanese culture and education, as well as a fundamental flaw in the way the Health Insurance scheme here operates.

When people in Taiwan get sick with anything, they go to the doctor. Even if they just have a runny nose or a dry cough, they will head straight to the nearest clinic. And they will expect to be prescribed something for it. The general understanding of modern medicine is that it can cure illness and relieve symptoms for everything.

This is wrong. Medicine has a very minimal effect on many minor ailments and in most countries around the world, if you have a cold and go to see a doctor, you will be told to stop wasting their time.

But not in Taiwan. Here, the doctors are more than happy to play along and no matter how minor your ailment, it is almost unheard of to leave a surgery without being prescribed at least two or three different remedies.

Why? Because that is how doctors here make their money. The more they prescribe, the more they get paid, so of course, they are incentivized to prescribe as much as possible.

It is a vicious circle and without a comprehensive shift in the way the National Health Insurance scheme funds doctors and a program to re-educate people about when modern medicine does and does not work, it will be impossible to escape.

There should be big incentives to make those changes too. Taiwan’s National Health Insurance scheme spends NT$160 billion a year on medication. This is taxpayer’s money and reducing unnecessary prescribing and medical waste could save a huge chunk of that, which could be reinvested in other areas of the health service which badly need it.

Taiwanese public health could also improve dramatically too. Overmedicating makes people’s immune systems less effective and therefore means they are more susceptible to getting sick. Less medication means in the long run people will be healthier. They will, therefore, be putting less burden on the health system and reduced sick days will also boost the country’s economy.

But there is a global implication in Taiwan’s prescription culture too. When medicine is used too freely, the viruses it is intended to combat have more of a chance to adapt to it. There is already plenty of concern about a number of viruses which have become resistant to antibiotics.

Global health policy dictates that antibiotics should only be prescribed when they are really needed. In Taiwan, that is absolutely not normal practice. Antibiotics are handed out like candy to anyone who heads to the doctor with so much as a temperature. And if that does contribute to resistant strains of viruses developing in Taiwan, they will quickly spread across the world.

If Taiwan was able to play a full and proper part in global health policy development, it would have a better chance to understand the importance of things like this and learn how to implement it in their own system.

Taiwan is desperate to take part in the WHA and play a full role in the World Health Organization more generally. Much of the rest of the world wants Taiwan to play a full part too. It is only Communist China, which is always more than willing to play politics with people’s lives, which objects.

Quite why the WHO feels the need to pander to Communist Party diktats in this way is unclear, but it is clear that their stance on Taiwan is against the interests of global public health.

Until they come to their senses, Taiwan will remain on the outside looking in. But it is still vital that they do everything they can to maintain international health policy standards in Taiwan.

Tackling over-prescribing and medical waste should be a central part of this. It is clear that the Ministry of National Health Insurance is aware of this issue. But now is the time to act, with bold policy changes that get to the root issue of the problem.